ISSN : 2146-3123
E-ISSN : 2146-3131

The Impact of Pre-transplant Cell-free DNA Levels on Leukemia Relapse and Transplant Related Complications in Allogeneic Hematopoietic Stem Cell Transplant Recipients
Zeynep Arzu Yeğin1, Ferda Can1, Sanem Gökçen1, Rezzan Eren Sadioğlu2, Zübeyde Nur Özkurt1, Çiğdem İlhan1, Münci Yağcı1
DOI : 10.4274/balkanmedj.galenos.2019.8.25

Background: Cell free DNA (cfDNA), which may be considered as “liquid” biopsy, may serve as a diagnostic and prognostic marker not only in hematological malignancies but in solid tumors as well.
Aims: The aim of this study is to investigate the prognostic role of pre-transplant cfDNA levels in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients.
Study Design: This study is a retrospective cohort study.
Methods: A total of 177 allo-HSCT recipients [median age: 36(16-66) years; male/female: 111/66] with an initial diagnosis of acute leukemia were included in the study. Cell free DNA was extracted from pre-transplant serum samples using the MagNA Pure Compact Nucleic Acid Isolation Kit I with the MagNA Pure Compact instrument (Roche Diagnostics, Penzberg, Germany).
Results: A positive correlation was demonstrated between cfDNA and age (p=0.018; r=0.177). Pre-transplant cfDNA levels were found to be lower in bcr-abl (+) patients (p=0.001), whilst an adverse correlation was indicated between cfDNA and bcr-abl levels (p=0.001; r=-0.531). Akut lymphoblastic leukemia patients with bcr-abl positivity (p=0.001) or abnormal cytogenetics (p=0.038) represented signficantly lower pre-transplant cfDNA levels. Cell free DNA levels were lower in patients who developed sinusoidal obstruction syndrome (p=0.035). In terms of long term complications, acute myeloid leukemia patients who experienced post-transplant relapse had significantly lower pre-transplant cfDNA levels (p=0.024). Overall survival was not statistically different between high- and low-cfDNA groups (45.2% vs 22.5; p=0.821).
Conclusion: In general, lower serum levels of pre-transplant cfDNA seem to be associated with transplant related morbidities and may be considered as an adverse prognostic factor for allo-HSCT recipients.

Keywords : acute lymphoblastic leukemia, acute myeloid leukemia, allogeneic hematopoietic stem cell transplantation, cell free DNA
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