vestimИзвестия Национальной академии наук Беларуси. Серия медицинских наукProceedings of the National Academy of Sciences of Belarus, Medical series1814-60232524-2350The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"vestim-367Research ArticleКЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНАCLINICAL AND EXPERIMENTAL MEDICINEДИНАМИКА ХИМЕРИЗМА КАК ФАКТОР ПРОГНОЗА РАЗВИТИЯ РЕЦИДИВОВ ПОСЛЕ АЛЛОГЕННОЙ ТРАНСПЛАНТАЦИИ ГЕМОПОЭТИЧЕСКИХ СТВОЛОВЫХ КЛЕТОК ПРИ ОНКОГЕМАТОЛОГИЧЕСКИХ ЗАБОЛЕВАНИЯХCHIMERISM AS A PROGNOSTIC FACTOR OF RELAPSE AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION IN HEMATOLOGICAL MALIGNANCIESЛавриненкоВ. А.LavrinenkoV. A.

науч. сотрудник

Researcher

avrnenkovictoria@gmail.comМарейкоЮ. Е.MareikaYu. E.

врач-гематолог

hematologist

mue@inbox.ruБерезовскаяЕ. Ю.BerezovskayaE. Yu.

биолог КДЛ

biologist of diagnostics laboratory

katarina-3004@mail.ruБыдановО. И.BydanovO. I.

инженер-программист

software engineer

budanov@oncology.byБелевцевМ. В.BelevtsevM. V.

канд. биол. наук, доцент, зам. директора по науке

Ph. D. (Biol.), Assistant Professor, Head of Research Department

belevtcev_m@mail.ruМинаковскаяН. В.MinakovskayaN. V.

канд. мед. наук, заведующий отделением

Ph. D. (Med.), Head of the Department

minakovskaya@tut.byАлейниковаО. В.AleynikovaO. V.

чл.-кор., д-р мед. наук, профессор, директор

Corresponding Member, D. Sc. (Med.), Professor, director

aleinikova2004@mail.ruРеспубликанский научно-практический центр детской онкологии, гематологии и иммунологииBelarusian Research Center for Pediatric Oncology, Hematology and Immunology201708082017022640Copyright © Лавриненко В.А., Марейко Ю.Е., Березовская Е.Ю., Быданов О.И., Белевцев М.В., Минаковская Н.В., Алейникова О.В., 20172017Лавриненко В.А., Марейко Ю.Е., Березовская Е.Ю., Быданов О.И., Белевцев М.В., Минаковская Н.В., Алейникова О.В.Lavrinenko V.A., Mareika Y.E., Berezovskaya E.Y., Bydanov O.I., Belevtsev M.V., Minakovskaya N.V., Aleynikova O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestimed.belnauka.by/jour/article/view/367

Рецидив основного заболевания остается одной из главных проблем и наиболее частых причин смертности после аллогенной трансплантации гемопоэтических стволовых клеток (аллоТГСК) у пациентов с онкогематологическими заболеваниями (ОГЗ). Мониторинг химеризма позволяет оценить приживление трансплантата и предсказать развитие рецидивов. Изучены результаты 104 аллоТГСК, которые были проведены с 2009 по 2016 г. у пациентов с ОГЗ. Установлено, что увеличивающийся смешанный химеризм (СХ) является неблагоприятным фактором прогноза для бес- событийной выживаемости (HR = 6,9, p < 0,0001) и ассоциирован с высоким риском развития рецидивов (HR = 12,2, p < 0,0001) после аллоТГСК. Бессобытийная выживаемость в группе с полным донорским (ПДХ), уменьшающимся СХ и увеличивающимся СХ составила 68,1 ± 6,4; 60,0 ± 21,9 и 0 % (p < 0,0001), кумулятивная частота развития рецидивов – 10,8 ± 4,6; 0 и 81,3 ± 10,8 % (p < 0,0001) соответственно. Увеличение клеток реципиента выявлялось за 2–435 (медиана 23,5) сут до гематологического рецидива в 10 (62,5%) из 16 случаев. Увеличивавшийся СХ раньше и чаще выявлялся в костном мозге, чем в периферической крови (p = 0,06). В разгар гематологического рецидива химеризм в периферической крови может быть полностью донорским. У пациентов с полным донорским химеризмом развитие острой реакции «трансплантат против хозяина» наблюдалось чаще, чем у пациентов с СХ (p = 0,0004). 

Relapse remains one of the main causes of treatment failure and mortality after allogeneic hematopoietic stem cell transplantation (alloHSCT) in patients with hematological malignancies. Chimerism monitoring provides information on engraftment and risk of relapse. The results of 104 alloHSCT performed in patients with hematological malignancies during 2009–2016 were included. Increasing mixed chimerism (MC) was an unfavorable prognostic factor for the event-free survival (EFS) (HR = 6.9, p < 0.0001) and was associated with a high risk of relapse after alloHSCT (HR = 12.2, p < 0.0001). EFS in patients with full donor chimerism (FDC), decreasing MC, increasing MC was 68.1 ± 6.4; 60.0 ± 21.9 and 0 % (p < 0.0001), the cumulative incidence of relapse was 10.8 ± 4.6; 0 and 81.3 ± 10.8 % (p < 0.0001), respectively. Increasing MC was detected in 2–435 (median 23.5) days before relapse in 10 (62.5 %) of 16 cases. Increasing MC appeared in bone marrow earlier and more often than in peripheral blood (p = 0.06). During hematologic relapse, FDC in peripheral blood can be observed. A graft-versushost disease was observed more often in patients with full donor chimerism than with MC (p = 0.0004).

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The authors declare that there are no conflicts of interest present.