Synapse - Ex vivo CD34(+)–selected T cell–depleted peripheral blood stem cell grafts for allogeneic hematopoietic stem cell transplantation in acute leukemia and myelodysplastic syndrome is associated with low incidence of acute and chronic graft-versus-host disease and high treatment response

Ex vivo CD34(+)–selected T cell–depleted peripheral blood stem cell grafts for allogeneic hematopoietic stem cell transplantation in acute leukemia and myelodysplastic syndrome is associated with low incidence of acute and chronic graft-versus-host disease and high treatment response Journal Article

Authors:	Barba, P.; Hilden, P.; Devlin, S. M.; Maloy, M.; Dierov, D.; Nieves, J.; Garrett, M. D.; Sogani, J.; Cho, C.; Barker, J. N.; Kernan, N. A.; Castro-Malaspina, H.; Jakubowski, A. A.; Koehne, G.; Papadopoulos, E. B.; Prockop, S.; Sauter, C.; Tamari, R.; van den Brink, M. R. M.; Avecilla, S. T.; Meagher, R.; O'Reilly, R. J.; Goldberg, J. D.; Young, J. W.; Giralt, S.; Perales, M. A.; Ponce, D. M.
Article Title:	Ex vivo CD34(+)–selected T cell–depleted peripheral blood stem cell grafts for allogeneic hematopoietic stem cell transplantation in acute leukemia and myelodysplastic syndrome is associated with low incidence of acute and chronic graft-versus-host disease and high treatment response
Abstract:	Ex vivo CD34+–selected T cell depletion (TCD) has been developed as a strategy to reduce the incidence of graft-versus-host disease (GVHD) after allogeneic (allo) hematopoietic stem cell transplantation (HSCT). Clinical characteristics, treatment responses, and outcomes of patients developing acute (aGVHD) and chronic GVHD (cGVHD) after TCD allo-HSCT have not been well established. We evaluated 241 consecutive patients (median age, 57 years) with acute leukemia (n = 191, 79%) or myelodysplastic syndrome (MDS) (n = 50, 21%) undergoing CD34+–selected TCD allo-HSCT without post-HCST immunosuppression in a single institution. Cumulative incidences of grades II-IV and III-IV aGVHD at 180 days were 16% (95% confidence interval [CI], 12 to 21) and 5% (95% CI, 3 to 9), respectively. The skin was the most frequent organ involved, followed by the gastrointestinal tract. Patients were treated with topical corticosteroids, poorly absorbed corticosteroids (budesonide), and/or systemic corticosteroids. The overall day 28 treatment response was high at 82%. The cumulative incidence of any cGVHD at 3 years was 5% (95% CI, 3 to 9), with a median time of onset of 256 days (range, 95 to 1645). The 3-year transplant-related mortality, relapse, overall survival, and disease-free survival were 24% (95% CI, 18 to 30), 22% (95% CI, 17 to 27), 57% (95% CI, 50 to 64), and 54% (95% CI, 47 to 61), respectively. The 1-year and 3-year probabilities of cGVHD-free/relapse-free survival were 65% (95% CI, 59 to 71) and 52% (95% CI, 45 to 59), respectively. Our findings support the use of ex vivo CD34+–selected TCD allograft as a calcineurin inhibitor–free intervention for the prevention of GVHD in patients with acute leukemia and MDS. © 2017 The American Society for Blood and Marrow Transplantation
Keywords:	acute graft-versus-host disease; chronic graft-versus-host disease; t cell–depleted transplantation
Journal Title:	Biology of Blood and Marrow Transplantation
Volume:	23
Issue:	3
ISSN:	1083-8791
Publisher:	Elsevier Inc.
Date Published:	2017-03-01
Start Page:	452
End Page:	458
Language:	English
DOI:	10.1016/j.bbmt.2016.12.633
PROVIDER:	scopus
PUBMED:	28017734
PMCID:	PMC5398850
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85009792211&doi=10.1016%2fj.bbmt.2016.12.633&partnerID=40&md5=211528e7d393e97dd255775b8c3f3b2d
Notes:	Article -- Export Date: 2 March 2017 -- Source: Scopus