Hematopoietic cell transplantation is the predominant curative treatment for many malignant and non-malignant hematological diseases. Each year, over 50,000 HCTs are performed world-wide. Better pre-transplantation matching methods, treatment and follow-up has led to increased patient survival, with nearly one million patients worldwide today living with donated hematopoietic cells.
Better post-transplant follow-up further improves the quality of life for these patients, as well as reduces health care costs. Early detection of graft rejection and disease relapse following HCT improves patient outcomes by allowing treatment to be initiated as quickly as possible after onset of relapse. In order to evaluate the level of donor engraftment, mixed chimerism levels must be carefully monitored after transplantation. While early detection makes a real difference in post-transplant patient management, the methods commonly used today are associated with challenges.
Laboratories have traditionally used a combination of STR-PCR and qPCR, two well-established methods for detecting mixed chimerism. Both have clear advantages and disadvantages. The STR-PCR-based methods generally show high precision but a restricted limit of detection (LOD); qPCR on the other hand exhibits a high sensitivity but poor precision, especially at higher levels of mixed chimerism.
Many laboratories now face escalating test volumes as the number of transplanted patients that require life-long monitoring grows, and testing becomes more frequent. This has created a need for a single, cost-effective method that combines the sensitive analysis of qPCR with the accurate measurements at high chimerism levels of STR fragment analysis. Next Generation Sequencing platforms (NGS) are suitable for developing assays for chimerism analysis with all the advantages of STR and qPCR without the drawbacks.
Devyser provides labs with one simple protocol for fast and reliable chimerism measurement and monitoring in transplanted patients. Complete relapse monitoring is possible with high sensitivity, accurate measurement and a custom software that makes it easy to follow chimerism trends in patients.
Lineage-specific early complete donor chimerism and risk of relapse after allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia. Lindahl, H., Vonlanthen, S., Valentini, D. et al. Bone Marrow Transplant (2022).
Performance Assessment of the Devyser High-Throughput Sequencing–Based Assay for Chimerism Monitoring in Patients after Allogeneic Hematopoietic Stem Cell Transplantation, Vynck M. et al, J Mol Diagn Volume 23, Issue 9, September 2021, 1116-1126
Is microchimerism a sign of imminent disease recurrence after allogeneic hematopoietic stem cell transplantation? A systematic review of the literature. Haugaard A.K. et al., Blood Reviews, Volume 44, November 2020, 100673
Evaluation of next-generation sequencing and crystal digital PCR for chimerism monitoring of post-allogeneic hematopoietic stem cell transplantation. P. Pedini et al., Transplant Cell Ther. 2021 Jan;27(1):89.e1-89.e10