ORIGINAL RESEARCH article
Front. Med.
Sec. Hematology
Clinical Impact of Early Microchimerism Dynamics after Transplantation with Enhanced Dual-Conditioning Regimen in Hematological Diseases
Provisionally accepted
- 1Nanjing Second Hospital, Nanjing (Zhongfu District), China
- 2Nanjing Lishui People's Hospital, Nanjing, China
- 3Southeast University Zhongda Hospital Department of Hematology, Nanjing, China
- 4Nanjing BenQ Medical Center, Nanjing, China
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Background: Microchimerism dynamics following allogeneic hematopoietic stem cell transplantation (allo-HSCT) may predict engraftment and clinical outcomes. This study aimed to quantify microchimerism changes and assess their clinical significance. Methods: In this retrospective study, eighteen patients undergoing allo-HSCT received either an enhanced dual-conditioning (EDCT) regimen (fludarabine/busulfan/cytarabine plus cyclophosphamide 200 mg/kg) or a modified EDCT regimen. Microchimerism levels were serially monitored from day +1 post-transplantation. Results: Complete donor chimerism (CDC) was achieved in 16/18 patients (88.9%) at a median time of 14 days (range, 9-24). The median neutrophil and platelet engraftment times were 15 days (range, 11-28) and 25 days (range, 10-80 in 16 patients who had platelet engraftment), respectively. Among them, eight patients retained constant CDC, 3 developed one increasing mixed chimerism (IMC), while 5 had multiple IMCs. Patients with constant CDC demonstrated faster platelet engraftment (median, 19.5 vs. 40 days, P=0.066) and superior overall survival (OS, median, not reached vs. 5.0 months, 95% CI 2-10 months, P=0.015). Notably, microchimerism trends differed between peripheral blood stem cell transplantation (PBSCT) and cord blood transplantation (CBT) recipients. The PBSCT group exhibited shorter neutrophil (median: 14.5 vs. 17.5 days, P=0.165) and platelet (median: 15 days vs. 40 days, P=0.009) engraftment times compared to the CBT group. However, the final CDC rates and OS times did not differ significantly between the two groups. Conclusions: Early microchimerism dynamics correlate with engraftment efficiency and survival outcomes in allo-HSCT patients, suggesting its clinical utility for timely intervention and personalized treatment adjustment. The promising long-term outcomes support the applicability of this regimen and monitoring approach across transplantation modalities.
Keywords: microchimerism, enhanced dual-conditioning regimen, Engraftment, Survival, Allo-HSCT
Received: 16 Oct 2025; Accepted: 17 Nov 2025.
Copyright: © 2025 Gu, Du, Yang and Ding. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jiahua Ding, 101007972@seu.edu.cn
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