Retrospective study of alemtuzumab vs ATG-based conditioning without irradiation for unrelated and matched sibling donor transplants in acquired severe aplastic anemia: a study from the British Society for Blood and Marrow Transplantation.

Abstract

This retrospective national study compared the use of alemtuzumab-based conditioning regimens for hematopoietic SCT (HSCT) in acquired severe aplastic anemia with antithymocyte globulin (ATG)-based regimens. One hundred patients received alemtuzumab and 55 ATG-based regimens. A matched sibling donor (MSD) was used in 87 (56%), matched unrelated donor (MUD) in 60 (39%) and other related or mismatched unrelated donor (UD) in 8 (5%) patients. Engraftment failure occurred in 9% of the alemtuzumab group and 11% of the ATG group. Five-year OS was 90% for the alemtuzumab and 79% for the ATG groups, P=0.11. For UD HSCT, OS of patients was better when using alemtuzumab (88%) compared with ATG (57%), P=0.026, although smaller numbers of patients received ATG. Similar outcomes for MSD HSCT using alemtuzumab or ATG were seen (91% vs 85%, respectively, P=0.562). A lower risk of chronic GVHD (cGVHD) was observed in the alemtuzumab group (11% vs 26%, P=0.031). On multivariate analysis, use of BM as stem cell source was associated with better OS and EFS, and less acute and cGVHD; young age was associated with better EFS and lower risk of graft failure. This large study confirms successful avoidance of irradiation in the conditioning regimens for MUD HSCT patients.

• Authors: J C Marsh, R M Pearce, M B C Koh, Z Lim, A Pagliuca, G J Mufti, J Perry, J A Snowden, A J Vora, R T Wynn, N Russell, B Gibson, M Gilleece, D Milligan, P Veys, S Samarasinghe, M McMullin, K Kirkland, G Cook, British Society for Blood and Marrow Transplantation, Clinical Trials Committee
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 49 Issue 1 Pg. 42-8 (Jan 2014) ISSN: 1476-5365 [Electronic] England
• PMID: 23912664 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Antibodies, Monoclonal, Humanized
• Antilymphocyte Serum
• Alemtuzumab

Topics

• Adolescent
• Adult
• Aged
• Alemtuzumab
• Anemia, Aplastic (therapy)
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Antilymphocyte Serum (therapeutic use)
• Bone Marrow Cells (cytology)
• Bone Marrow Transplantation (methods)
• Child
• Child, Preschool
• Female
• Graft Survival
• Graft vs Host Disease
• Humans
• Infant
• Male
• Middle Aged
• Peripheral Blood Stem Cell Transplantation (methods)
• Registries
• Retrospective Studies
• Risk Factors
• Siblings
• Tissue Donors
• Transplantation Conditioning (methods)
• Treatment Outcome
• United Kingdom
• Young Adult