Expert Review 08
Overcoming limitations in the detection of mixed chimerism by Dr. Dan Hauzenberger
This paper highlights the importance of chimerism as a diagnostic tool for clinicians treating transplanted patients. Furthermore, the evolution of novel diagnostic tools for early detection of mixed chimerism is discussed. The recent development of NGS technology offers the possibility to analyse mixed chimerism with both sensitivity, as well as accurate and precise determination.
This paper is authored by Dr. Dan Hauzenberger, Medical Director of the Section for Transplantation Immunology at Karolinska University Hospital, Sweden.
What you'll learn
- Importance of detecting mixed chimerism
- Methods for detection of mixed chimerism
- Recent development of NGS technology and its possibilities
The introduction of hematopoietic stem cells (HSC) from bone marrow (BM) or peripheral blood (PB) as a curative treatment for patients with malignant or non-malignant haematological diseases has been one of the major medical advancements of the last 30 years. In 1957 the first attempt at performing bone marrow transplantation was made in several patients suffering from malignant hematological diseases (Thomas, Lochte et al. 1957).
Early attempts at using hematopoietic allogeneic stem cell transplantation (HSCT) for treatment were however poor with many patients dying in complications directly related to the transplantation. However, with increasing knowledge of the importance of the polymorphic HLA system (Human Leucocyte Antigens) and immunosuppression, results of transplantations improved and are today the only curative treatment for patients with malignant or non-malignant haematological diseases (Ringden, Groth et al. 1995, Ringden, Lonnqvist et al. 1995).
Today more than 50 000 patients annually undergo HSCT world-wide. The majority of these patients have an underlying malignant disease such as acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), chronic myeloid leukemia in blast phase, Myelodysplastic Syndrome (MDS), multiple myeloma, high-risk lymphomas and Hodgkin’s disease. Furthermore, several non-malignant diseases can also be treated successfully using HSCT. Among them are several immunodeficiencies, such as severe combined immunodeficiency (SCID), Wiskott-Aldrich syndrome, and common variable immunodeficiency (CVI) (Saba and Flaig 2002).