Pre-emptive Immunotherapy based on Post-transplant Chimerism and MRD Monitoring

An effective strategy to prevent relapse after allogeneic stem cell transplantation in children with ALL

Mixed chimerism (MC) and Minimal Residual Disease (MRD) strongly predict relapse in children with ALL after allo-SCT. Pre-emptive immunotherapy (IT), e.g. withdrawal of immunosuppression (WD-IS) or Donor Lymphocyte Infusion (DLI) can prevent impending relapse. We retrospectively analyzed chimerism and MRD monitoring and the effect of pre-emptive IT.

    EFS CI Relapse


      • Analysis of MRD and chimerism post-transplant are predictive for relapse
        MRD positivity and MC is associated with relapse
        MRD negativity or Complete Chimersism (CC) at one time point does not exclude relapse
      • Serial analysis of MRD and chimerism allows for the prediction of relapse in virtually all patients
      • Consequence:
        MRD positivity and MC can be efficiently treated by IT
        IT is safe and does not increase risk for treatment-related mortality