Comparative outcomes of donor graft CD34 + selection and immune suppressive therapy as graft-versus-host disease prophylaxis for patients with acute myeloid leukemia in complete remission undergoing HLA-matched sibling allogeneic hematopoietic cell transplantation Journal Article
| Authors: | Pasquini, M. C.; Devine, S.; Mendizabal, A.; Baden, L. R.; Wingard, J. R.; Lazarus, H. M.; Appelbaum, F. R.; Keever-Taylor, C. A.; Horowitz, M. M.; Carter, S.; O'Reilly, R. J.; Soiffer, R. J. |
| Article Title: | Comparative outcomes of donor graft CD34 + selection and immune suppressive therapy as graft-versus-host disease prophylaxis for patients with acute myeloid leukemia in complete remission undergoing HLA-matched sibling allogeneic hematopoietic cell transplantation |
| Abstract: | Purpose: T-cell depletion (TCD) reduces the incidence of graft-versus-host disease (GVHD) after hematopoietic cell transplantation (HCT). However, concerns about relapse, graft rejection, and variability in technique have limited the widespread application of this approach. Patients and Methods: Outcomes of 44 patients receiving HLA-identical sibling TCD grafts using a uniform technique for CD34 + selection as the sole form of immune suppression were compared with outcomes of 84 patients receiving T-replete grafts and pharmacologic immune suppression therapy (IST). Results: Groups were similar, except for fewer men (36% with TCD v 56% with IST) and more frequent use of radiation-containing regimens (100% with TCD v 50% with IST) in the CD34-selected TCD cohort. The proportion of patients with neutrophil engraftment at day 28 was similar (96% with IST and 100% with TCD grafts). The 100-day rates of grade 2 to 4 acute GVHD were 39% and 23% with IST and TCD grafts, respectively (P = .07). Corresponding 2-year rates of chronic GVHD were lower with TCD grafts than IST (19% v 50%, respectively; P < .001). There were no differences in rates of graft rejection, leukemia relapse, treatment-related mortality, and disease-free and overall survival rates. At 1 year, 54% and 12% of patients were still on immunosuppression in the IST and TCD cohorts, respectively. TCD was associated with a higher GVHD-free survival at 2 years compared with IST (41% v 19%, respectively; P = .006). Conclusion: These results suggest that TCD via CD34 selection might lower long-term morbidity as a result of chronic GVHD without negatively impacting relapse rates in patients with acute myeloid leukemia. Additional prospective studies should be undertaken to definitively address the role of TCD in HCT. © 2012 by American Society of Clinical Oncology. |
| Keywords: | adult; cancer survival; controlled study; aged; survival rate; acute granulocytic leukemia; major clinical study; overall survival; busulfan; fludarabine; mortality; monotherapy; cancer patient; disease free survival; methotrexate; outcome assessment; low drug dose; etoposide; randomized controlled trial; cohort analysis; cyclophosphamide; thiotepa; cause of death; engraftment; whole body radiation; neutrophil; graft versus host reaction; allogeneic hematopoietic stem cell transplantation; cancer relapse; virus infection; sibling; corticosteroid; t cell depletion; immunosuppressive treatment; tacrolimus; hla typing; mycophenolic acid 2 morpholinoethyl ester; bacterial infection; cd34 selection; mycosis; cyclosporin; immunosuppressive agent; thymocyte antibody; protozoal infection |
| Journal Title: | Journal of Clinical Oncology |
| Volume: | 30 |
| Issue: | 26 |
| ISSN: | 0732-183X |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 2012-09-10 |
| Start Page: | 3194 |
| End Page: | 3201 |
| Language: | English |
| DOI: | 10.1200/jco.2012.41.7071 |
| PROVIDER: | scopus |
| PMCID: | PMC3434978 |
| PUBMED: | 22869882 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 1" - "Export Date: 2 November 2012" - "CODEN: JCOND" - "Source: Scopus" |
