Original Articles
Vol. 18 No. 1 (2026): Mediterranean Journal of Hematology and Infectious Diseases
POST-TRANSPLANT RELAPSE IN ACUTE LEUKEMIA: COMPARATIVE VALUE OF MRD AND CHIMERISM.
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: February 28, 2026
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Background: Relapse remains the leading cause of treatment failure after allogeneic hematopoietic stem cell transplantation (AHSCT) in acute leukemia. Early molecular detection is critical for timely intervention. Measurable residual disease (MRD) and donor chimerism are routinely used for post-transplant monitoring, yet their comparative predictive value is uncertain.
Aims: To compare the prognostic utility of MRD and donor chimerism in predicting relapse after AHSCT in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL).
Methods: This retrospective cohort included 264 adults (186 AML, 78 ALL) who underwent AHSCT. MRD was assessed by multiparametric flow cytometry on day 28 and at months 3 and 12, and chimerism by short tandem repeat PCR. Cox regression identified independent relapse predictors.
Results: Ninety-five patients relapsed (68 AML, 27 ALL). In AML, MRD positivity at month 3 (HR = 3.69, p < 0.001) and mixed chimerism (MC) (HR = 2.47, p = 0.029) were independent relapse predictors and correlated with inferior survival. MRD predicted relapse in 60% of AML cases versus 38% for MC. In ALL, only T-cell lineage independently predicted relapse (HR = 3.94, p = 0.016).
Conclusion: Post-transplant MRD monitoring at month 3 is a stronger independent predictor of relapse than chimerism in AML, while in ALL, the small cohort size limits statistical power; thus, the roles of MRD and chimerism should be interpreted cautiously.
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“POST-TRANSPLANT RELAPSE IN ACUTE LEUKEMIA: COMPARATIVE VALUE OF MRD AND CHIMERISM”. (2026) Mediterranean Journal of Hematology and Infectious Diseases, 18(1). doi:10.4084/MJHID.2026.028.
Copyright (c) 2026 Sinem Başak Tan Öksüz, Güldane Cengiz Seval, Klara Dalva, Selami Koçak Toprak
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