Graft failure after T-cell-depleted human leukocyte antigen identical marrow transplants for leukemia: I. Analysis of risk factors and results of secondary transplants Journal Article


Authors: Kernan, N. A.; Bordignon, C.; Heller, G.; Cunningham, I.; Castro-Malaspina, H.; Shank, B.; Flomenberg, N.; Burns, J.; Yang, S. Y.; Black, P.; Collins, N. H.; O'Reilly, R. J.
Article Title: Graft failure after T-cell-depleted human leukocyte antigen identical marrow transplants for leukemia: I. Analysis of risk factors and results of secondary transplants
Abstract: Risk factors for graft failure were analyzed in 122 recipients of an allogeneic T-cell-depleted human leukocyte antigen (HLA)-identical sibling marrow transplant as treatment for leukemia. In each case pretransplant immunosuppression included 1,375 to 1,500 cGy hyperfractionated total body irradiation and cyclophosphamide (60 mg/kg/d x 2). No patient received immunosuppression posttransplant for graft-versus-host disease (GVHD) prophylaxis. Nineteen patients in this group experienced graft failure. The major factors associated with graft failure were transplants from male donors and the age of the patient (or donor). Among male recipients of male donor derived grafts a low dose per kilogram of nucleated cells, progenitor cells (colony forming unit-GM) and T cells was also associated with graft failure. Additional irradiation to 1,500 cGy, high dose corticosteroids posttransplant, and additional peripheral blood donor T cells did not decrease the incidence of graft failure. In addition, type of leukemia, time from diagnosis to transplant, an intact spleen, or the presence of antidonor leukocyte antibodies did not correlate with graft failure. To ensure engraftment of secondary transplants, further immunosuppression was necessary but was poorly tolerated. However, engraftment and survival could be achieved with an immunosuppressive regimen in which antithymocyte globulin and high dose methylprednisolone were administered both before and after infusions of secondary partially T-cell-depleted marrow grafts.
Keywords: adolescent; adult; school child; leukemia; major clinical study; t-lymphocytes; risk factors; cyclophosphamide; age factors; irradiation; graft versus host reaction; methylprednisolone; multivariate analysis; leukocyte count; graft survival; sex factors; immunosuppressive treatment; bone marrow transplantation; leukocyte antigen; oral drug administration; immunosuppression; histocompatibility; antilymphocyte serum; human; male; female; priority journal; support, non-u.s. gov't; support, u.s. gov't, p.h.s.
Journal Title: Blood
Volume: 74
Issue: 6
ISSN: 0006-4971
Publisher: American Society of Hematology  
Date Published: 1989-11-01
Start Page: 2227
End Page: 2236
Language: English
PUBMED: 2804361
PROVIDER: scopus
DOI: 10.1182/blood.V74.6.2227.2227
DOI/URL:
Notes: Article -- Export Date: 14 April 2020 -- Source: Scopus
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Citation Impact
MSK Authors
  1. Soo Y Yang
    86 Yang
  2. Nancy Kernan
    445 Kernan
  3. Glenn Heller
    356 Heller
  4. Richard O'Reilly
    602 O'Reilly
  5. Nancy Collins
    72 Collins
  6. Patricia   Black
    26 Black
  7. Brenda M. Shank
    20 Shank