| Abstract: |
Allogeneic hematopoietic stem cell transplantation (HSCT) is established therapy for selected patients with acute leukemia. After transplantation, antileukemic immune responses are believed to eliminate residual leukemia cells and decrease the likelihood of relapse. However, the clinical effect of successful antigen-specific immune reconstitution after HSCT on the likelihood of leukemic relapse and overall survival is not known. Pediatric recipients of unrelated cord blood transplants who underwent transplantation for acute leukemia were sequentially evaluated for their development of antigen-specific T-lymphocyte immunity to herpes viruses. The clinical effect of a positive antigen-specific response on relapse-free survival was determined. The presence of an antigen-specific response resulted in a relapse-free survival advantage (P = .0001), which was primarily due to a decrease in leukemic relapse (P = .003). Proportional hazards modeling for time to relapse and time to relapse or death defined 3 variables that were strongly associated with a poor outcome: female gender, poor remission status before transplantation, and negative antigen-specific T-lymphocyte proliferation. Notably neither acute nor chronic graft-versus-host disease had any effect on the incidence of leukemic relapse. Successful antigen-specific immune reconstitution after unrelated cord blood transplantation results in decreased leukemic relapse and improved overall survival. © 2006 American Society for Blood and Marrow Transplantation. |
| Keywords: |
adolescent; cancer survival; child; controlled study; child, preschool; disease-free survival; recovery of function; transplantation, homologous; acute granulocytic leukemia; major clinical study; overall survival; leukemia, myeloid, acute; busulfan; clinical trial; recurrence risk; follow-up studies; cd3 antigen; cd8 antigen; lymphocyte proliferation; t lymphocyte; controlled clinical trial; phase 2 clinical trial; recurrence; aciclovir; cyclophosphamide; melphalan; herpes simplex; herpes zoster; cancer mortality; acute lymphoblastic leukemia; time; acute graft versus host disease; chronic graft versus host disease; cord blood stem cell transplantation; whole body radiation; proportional hazards model; cellular immunity; immune response; antigen specificity; infant; remission induction; outcomes research; allogeneic hematopoietic stem cell transplantation; precursor cell lymphoblastic leukemia-lymphoma; tumor immunity; immunophenotyping; methylprednisolone; sex difference; cd4 antigen; sex factors; childhood leukemia; leukemia relapse; risk reduction; bacterial infection; ganciclovir; cytomegalovirus infection; mycosis; cyclosporin; cd19 antigen; antiviral activity; cd45ra antigen; thymocyte antibody; virus immunity; leukemia remission; immune reconstitution; graft vs leukemia effect; cd56 antigen; leukemia, lymphocytic, acute, l1; leukemia, myelocytic, acute
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