Summary:Monitoring the engraftment of donor cells after allogeneic blood stem cell transplantation (BSCT) may be important for the early diagnosis of graft failure or relapse of disease. Several techniques have been reported for this purpose. PCR-based assays analyzing polymorphic short tandem repeat (STR) markers are attractive because they are sensitive and can be performed rapidly. The intent of the present study was to test a novel approach for the quantification of mixed chimerism using a commercial multiplex STR assay with fluorescence-based detection for forensic purposes. The feasibility of this assay and the accuracy of quantitative results was tested using serial cell mixtures of unrelated individuals. Sample preparation was optimized to obtain information from minute amounts of starting material, eg from patients with aplasia or from sorted cell populations. Using the STR-PCR, discrimination between donor and recipient was possible in all patients analyzed (n = 25). Cell dilution experiments showed a linear correlation between the cell numbers added and the proportions found, with the limit of detection for a minor cell population being 5%. Comparison of values obtained with standard FISH analysis in patients transplanted from sex-mismatched donors showed an excellent correlation with the STR-PCR results. Taken together, this procedure allows the rapid, versatile and accurate quantification of mixed chimerism, even with minuscule numbers of cells. Keywords: chimerism; short-tandem repeats (STR); quantification; PCR; fluorescence detection Allogeneic blood stem cell transplantation is frequently performed in patients with nonmalignant and malignant hematological diseases such as severe aplastic anemia (SAA), severe combined immunodeficiency (SCID), acute and chronic leukemia and lymphoma. Detection of the degree of chimerism after transplantation is an important method for monitoring the engraftment of donor cells and allows early detection of graft failure. This seems to be especially important in patients at risk for graft failure, ie patients Correspondence: C Thiede, Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus der Technischen Universität, Fetscherstrasse 74, 01307 Dresden, Germany Received 12 September 1998; accepted 4 January 1999 receiving T cell-depleted stem cell grafts from unrelated donors.1 In addition, novel therapeutic approaches like nonmyeloablative stem cell transplantation 2,3 are dependent on rapid information on the degree of mixed chimerism to schedule therapeutic interventions, eg donor lymphocyte infusion (DLI).Several approaches have been published for the detection of chimerism. In sex-mismatched transplantation settings, information on the ratio between donor and recipient can be obtained efficiently and rapidly by using fluorescent in situ hybridization (FISH) with probes specific for X-and Y-chromosome.4,5 PCR-based amplification of a single variable number of tandem repeat (VNTR) or short tandem repeat (STR) markers is another frequently perf...