Ex vivo T cell-depleted versus unmodified allografts in patients with acute myeloid leukemia in first complete remission.

Abstract

This study was conducted to retrospectively compare the clinical outcomes after transplantation of T cell-depleted (TCD) and unmodified allografts in patients with acute myeloid leukemia (AML) in first complete remission (CR1). Patients received TCD grafts at Memorial Sloan-Kettering Cancer Center (MSKCC, N = 115) between 2001 and 2010 using the following preparative regimens: hyperfractionated total body irradiation (HFTBI)+thiotepa+fludarabine; HFTBI+thiotepa+cyclophosphamide; or i.v. busulfan+melphalan+fludarabine. TCD was performed by 1 of 2 immunomagnetic CD34(+) cell selection methods for peripheral blood grafts or by soybean lectin agglutination followed by sheep red blood cell-rosette depletion for bone marrow grafts. No additional graft-versus-host disease (GVHD) prophylaxis was administered. Patients received unmodified grafts at M.D. Anderson Cancer Center (MDACC, N = 181) after conditioning with busulfan+fludarabine and GVHD prophylaxis with tacrolimus+mini-methotrexate. Patients with unrelated or human leukocyte antigen-mismatched donors received anti-thymocyte globulin (ATG) at both centers, with some recipients of matched related donor TCD transplants also receiving ATG, depending upon the preparative regimen. TCD graft recipients were more likely to be older, receive a mismatched transplant, and have peripheral blood used as the graft source. The incidences rates of grades 2 to 4 acute GVHD and chronic GVHD were significantly lower in the TCD graft group (5% versus 18%, and 13% versus 53%). Three-year relapse-free and overall survival rates were 58% and 57%, respectively, in recipients of TCD grafts, and 60% and 66% in recipients of unmodified grafts (P = not significant). Survival and relapse-free survival are similar after TCD and conventional transplants from related/unrelated donors in patients with AML in CR1, but TCD significantly reduces GVHD.

• Authors: Ulas D Bayraktar, Marcos de Lima, Rima M Saliba, Molly Maloy, Hugo R Castro-Malaspina, Julianne Chen, Gabriela Rondon, Alexander Chiattone, Ann A Jakubowski, Farid Boulad, Nancy A Kernan, Richard J O'Reilly, Richard E Champlin, Sergio Giralt, Borje S Andersson, Esperanza B Papadopoulos
• Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 19 Issue 6 Pg. 898-903 (Jun 2013) ISSN: 1523-6536 [Electronic] United States
• PMID: 23467126 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antilymphocyte Serum
• Thiotepa
• Vidarabine
• Busulfan
• fludarabine
• Melphalan

Topics

• Adult
• Aged
• Antilymphocyte Serum (administration & dosage)
• Antineoplastic Combined Chemotherapy Protocols
• Bone Marrow Transplantation
• Busulfan (administration & dosage)
• Female
• Graft vs Host Disease (immunology, mortality, pathology, therapy)
• Hematopoietic Stem Cell Transplantation
• Humans
• Leukemia, Myeloid, Acute (immunology, mortality, pathology, therapy)
• Lymphocyte Depletion
• Male
• Melphalan (administration & dosage)
• Middle Aged
• Recurrence
• Remission Induction
• Retrospective Studies
• Survival Analysis
• T-Lymphocytes (immunology, pathology)
• Thiotepa (administration & dosage)
• Transplantation, Homologous
• Treatment Outcome
• Vidarabine (administration & dosage, analogs & derivatives)