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"
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  1. Richard O'Reilly
    487 O'Reilly