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• W2327033412 abstract "The CIBMTR is conducting a non-inferiority study of IV busulfan-based conditioning regimens vs. traditional ablative cyclophosphamide and TBI in patients (pts) with myeloid malignancies undergoing related or unrelated SCT. Of 1750 pts, we describe the practices and outcomes of chimerism testing in 155 pts who received RIC in this study. 7 had no chimerism testing; data is available on 140 pts. A total of 807 chimerism assays were performed. Initial chimerism testing was most commonly performed at ∼day 30 (95/140pts) while only a small percentage had their first chimerism >/ = 90 days post-SCT (19/140pts). Chimerism testing was performed at a median of 3 (1-6) time points with a median of 5 (1-24) separate assays per patient. Multiple cell types (at least 3 types) were assayed (e.g. BM +/- PB MNC +/- lymphocytes +/- lineage specific cells) in 45 pts, often at one time point. Other common patterns of testing in a single episode of care were BM + PBMC (n32), PBMC only (n23), PB T and B cells (n18), BM only (n13) and other combinations (n9). In 62 instances chimerism was performed on the BM and PB at the same time. BM chimerism differed by <10% from PBMC in 21, myeloid cells in 15 and T cells in 15 assays. BM chimerism was at least 10% lower than PB, M or T cell chimerism in 9/62 assays while PB chimerism was at least 10% lower than BM chimerism twice. Engraftment (>90% donor chimerism) occurred in at least one cell line in 124 of 140 pts. The vast majority of pts achieved this by day 60 post-SCT. 28 pts subsequently lost full chimerism; 25 in association with disease (dx) progression, 3 without progression. 33 pts had dx progression and/or died without losing full donor chimerism. 3 pts achieved only myeloid donor chimerism; all are alive without dx progression. 4 pts had testing but did not report results. With a median follow up of 12 mos, 85 pts are alive, 56 without dx progression and with full donor chimerism. Chimerism is commonly performed following RIC regimens but practices vary widely even within centers and individual pts. Although loss of donor chimerism is most commonly related to dx progression, maintenance of chimerism does not exclude dx progression, bringing into question the role of serial monitoring. Outside of a research protocol, for pts receiving IV busulfan-based RIC, chimerism at a single time point (∼d60) to confirm engraftment with no further routine testing would be cost effective. The CIBMTR is conducting a non-inferiority study of IV busulfan-based conditioning regimens vs. traditional ablative cyclophosphamide and TBI in patients (pts) with myeloid malignancies undergoing related or unrelated SCT. Of 1750 pts, we describe the practices and outcomes of chimerism testing in 155 pts who received RIC in this study. 7 had no chimerism testing; data is available on 140 pts. A total of 807 chimerism assays were performed. Initial chimerism testing was most commonly performed at ∼day 30 (95/140pts) while only a small percentage had their first chimerism >/ = 90 days post-SCT (19/140pts). Chimerism testing was performed at a median of 3 (1-6) time points with a median of 5 (1-24) separate assays per patient. Multiple cell types (at least 3 types) were assayed (e.g. BM +/- PB MNC +/- lymphocytes +/- lineage specific cells) in 45 pts, often at one time point. Other common patterns of testing in a single episode of care were BM + PBMC (n32), PBMC only (n23), PB T and B cells (n18), BM only (n13) and other combinations (n9). In 62 instances chimerism was performed on the BM and PB at the same time. BM chimerism differed by <10% from PBMC in 21, myeloid cells in 15 and T cells in 15 assays. BM chimerism was at least 10% lower than PB, M or T cell chimerism in 9/62 assays while PB chimerism was at least 10% lower than BM chimerism twice. Engraftment (>90% donor chimerism) occurred in at least one cell line in 124 of 140 pts. The vast majority of pts achieved this by day 60 post-SCT. 28 pts subsequently lost full chimerism; 25 in association with disease (dx) progression, 3 without progression. 33 pts had dx progression and/or died without losing full donor chimerism. 3 pts achieved only myeloid donor chimerism; all are alive without dx progression. 4 pts had testing but did not report results. With a median follow up of 12 mos, 85 pts are alive, 56 without dx progression and with full donor chimerism. Chimerism is commonly performed following RIC regimens but practices vary widely even within centers and individual pts. Although loss of donor chimerism is most commonly related to dx progression, maintenance of chimerism does not exclude dx progression, bringing into question the role of serial monitoring. Outside of a research protocol, for pts receiving IV busulfan-based RIC, chimerism at a single time point (∼d60) to confirm engraftment with no further routine testing would be cost effective." @default.
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• W2327033412 date "2012-02-01" @default.
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• W2327033412 title "Chimerism Testing with Reduced Intensity Intravenous Busulfan-Based Conditioning Regimens: Once Is Enough" @default.
• W2327033412 doi "https://doi.org/10.1016/j.bbmt.2011.12.335" @default.
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