Role of cerebrospinal fluid chimerism in predicating central nervous relapse surveillance for patients of acute leukemia after allogeneic hematopoietic stem cell transplantation

Objective To explore the role of cerebrospinal fluid chimerism in central nervous relapse surveillance for patients of acute leukemia after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods The follow-up data were retrospectively collected and analyzed in 104 patients with acute leukemia after allo-HSCT. Comparisons were made between patients with complete chimerism and mixed chimerism in cerebrospinal fluid. The role of recipient DNA percentage and its changing trend in predicting central nervous relapse were also explored. Analysis was conducted for determining the risk factors of central nervous relapse. And the effectiveness of prophylaxis with intrathecal injection was also examined. Results The incidence of relapse was higher in patients with mixed chimerism (P<0.001), high percentage of recipient DNA (P<0.05) and higher mixed chimerism (P<0.001). Hyperleukocytosis at an initial diagnosis was a risk factor of central nervous relapse. Whether or not intrathecal injection prophylaxis was applied showed no significant difference in relapsing rate. Conclusions Monitoring cerebrospinal fluid chimerism can effectively help predict central nervous relapse among patients of acute leukemia after allo-HSCT. Yet intrathecal injection prophylaxis failed to benefit recipients. Key words: Allogeneic hematopoietic stem cell transplantation; Cerebrospinal fluid; Central nervous relapse