Autologous transplantation with CD52 monoclonal antibody-purged marrow for acute lymphoblastic leukemia: long-term follow-up.

Abstract

During 1984-86, 23 patients (5-37 years, median 16) with acute lymphoblastic leukemia (ALL) in first remission (n = 11) or beyond (n = 12) underwent autologous transplantation (ABMT) using marrow purged with the rat anti-CD52 monoclonal antibody Campath-1M after melphalan and total-body irradiation (TBI). Median time to 0.5 x 10(9)/L neutrophils and 50 x 10(9)/L platelets was 38 and 51 days respectively. Myeloid engraftment was significantly slower compared with ALL patients receiving unpurged marrow (P = .01). Eight patients died due to transplant-related causes 53-205 days after the procedure. Six of eight patients receiving 1150 cGy TBI died of toxicity compared with two of 15 receiving less than 1150 cGy (P = .006, Fisher's exact test). Nine patients relapsed at 45-195 days (median 97); eight died and one is alive at nine years in a chemotherapy-induced remission. Six patients are alive and well in continuous remission 9-10 years (median 10) after transplant. The 10-year probabilities of disease-free survival and relapse are 26% (95% CI: 11-45%) and 51% (95% CI: 37-59%) respectively. We conclude that it is feasible to purge marrow for autografting using Campath-1M without killing normal stem cells. Myeloid engraftment is slow but consistent, and long-term survival is seen in a proportion of patients. The role of CD52 monoclonal antibodies for purging in ALL still requires further study.

• Authors: J Mehta, R Powles, J Treleaven, C Horton, V Shepherd, G Hale, H Waldmann, S Singhal
• Journal: Leukemia & lymphoma (Leuk Lymphoma) Vol. 25 Issue 5-6 Pg. 479-86 (May 1997) ISSN: 1042-8194 [Print] United States
• PMID: 9250818 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Antibodies, Monoclonal
• Antigens, CD
• Antigens, Neoplasm
• CD52 Antigen
• CD52 protein, human
• Cd52 protein, rat
• Glycoproteins
• Mercaptopurine
• Melphalan
• Methotrexate

Topics

• Adolescent
• Adult
• Animals
• Antibodies, Monoclonal
• Antigens, CD (immunology)
• Antigens, Neoplasm
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Bone Marrow Purging (methods)
• Bone Marrow Transplantation
• CD52 Antigen
• Child
• Child, Preschool
• Combined Modality Therapy
• Female
• Follow-Up Studies
• Glycoproteins
• Humans
• Male
• Melphalan (administration & dosage)
• Mercaptopurine (administration & dosage)
• Methotrexate (administration & dosage)
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (drug therapy, radiotherapy, therapy)
• Rats
• Time Factors
• Transplantation, Autologous
• Whole-Body Irradiation