T cell-depleted stem-cell transplantation for adults with hematologic malignancies: Sustained engraftment of HLA-matched related donor grafts without the use of antithymocyte globulin Journal Article

   

Authors:	Jakubowski, A. A.; Small, T. N.; Young, J. W.; Kernan, N. A.; Castro-Malaspina, H.; Hsu, K. C.; Perales, M. A.; Collins, N.; Cisek, C.; Chiu, M.; van den Brink, M. R. M.; O'Reilly, R. J.; Papadopoulos, E. B.
Article Title:	T cell-depleted stem-cell transplantation for adults with hematologic malignancies: Sustained engraftment of HLA-matched related donor grafts without the use of antithymocyte globulin
Abstract:	Antithymocyte globulin (ATG) has been used in allogeneic stem-cell transplantation to prevent graft rejection and graft-versus-host disease (GvHD). Its use, however, has been associated with delayed T-cell reconstitution and prolonged susceptibility to opportunistic infections (OIs) especially in patients undergoing T cell-depleted (TCD) transplantation. Recently, a prospective trial was conducted in 52 adult patients (median age, 47 years) with various hematologic malignancies undergoing TCD transplantation from HLA-matched related donors without the use of ATG. The cytoreductive regimen consisted of hyperfractionated total body irradiation (HFTBI), thiotepa, and fludarabine. The preferred source of the graft was peripheral blood stem cells (PBSCs). No additional graft rejection or GvHD prophylaxis was given. All evaluable patients engrafted without any immune-mediated graft rejections. Disease-free survival (DFS) at 3 years was 61% in all patients, and 70% in patients with standard-risk disease. Acute GvHD was limited to grade 2 in 8% and chronic GvHD in 9% of patients. Life-threatening OIs occurred in 3 of 52 patients and was fatal in 1. This study demonstrates durable engraftment with a low incidence of GvHD despite the lack of ATG, as well as the curative potential of this regimen. © 2007 by The American Society of Hematology.
Keywords:	adult; controlled study; disease-free survival; middle aged; transplantation, homologous; major clinical study; fludarabine; clinical trial; disease free survival; methodology; cytoreductive surgery; incidence; stem cell transplantation; hematopoietic stem cell transplantation; thiotepa; risk assessment; acute graft versus host disease; hematologic malignancy; hla matching; whole body radiation; blood disease; hematologic neoplasms; peripheral blood stem cell; graft versus host reaction; transplantation conditioning; graft survival; t cell depletion; immunosuppressive treatment; graft vs host disease; hla antigen; hla antigens; lymphocyte depletion; allotransplantation; opportunistic infections; thymocyte antibody; opportunistic infection; lymphocyte antibody; antilymphocyte serum
Journal Title:	Blood
Volume:	110
Issue:	13
ISSN:	0006-4971
Publisher:	American Society of Hematology
Date Published:	2007-12-15
Start Page:	4552
End Page:	4559
Language:	English
DOI:	10.1182/blood-2007-06-093880
PUBMED:	17717135
PROVIDER:	scopus
PMCID:	PMC2234775
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-39649110913&partnerID=40&md5=c821993b82d5b9477a27fa17b8d723da
Notes:	--- - "Cited By (since 1996): 22" - "Export Date: 17 November 2011" - "CODEN: BLOOA" - "Source: Scopus"