Comparison of outcomes at two institutions of patients with ALL receiving ex vivo T-cell-depleted or unmodified allografts Journal Article

   


Authors: Hobbs, G. S.; Hamdi, A.; Hilden, P. D.; Goldberg, J. D.; Poon, M. L.; Ledesma, C.; Devlin, S. M.; Rondon, G.; Papadopoulos, E. B.; Jakubowski, A. A.; O'Reilly, R. J.; Champlin, R. E.; Giralt, S.; Perales, M. A.; Kebriaei, P.
Article Title: Comparison of outcomes at two institutions of patients with ALL receiving ex vivo T-cell-depleted or unmodified allografts
Abstract: We compared outcomes of adult patients receiving T-cell-depleted (TCD) hematopoietic SCT (HCT) without additional GVHD prophylaxis at Memorial Sloan Kettering Cancer Center (MSKCC, N=52), with those of patients receiving conventional grafts at MD Anderson Cancer Center (MDACC, N=115) for ALL in CR1 or CR2. Patients received myeloablative conditioning. Thirty-nine patients received anti-thymocyte globulin at MSKCC and 29 at MDACC. Cumulative incidence of grades 2-4 acute (P=0.001, 17.3% vs 42.6% at 100 days) and chronic GVHD (P=0.006, 13.5% vs 33.4% at 3 years) were significantly lower in the TCD group. The non-relapse mortality at day 100, 1 and 3 years was 15.4, 25.0 and 35.9% in the TCD group and 9.6, 23.6 and 28.6% in the unmodified group (P=0.368). There was no difference in relapse (P=0.107, 21.3% vs 35.5% at 3 years), OS (P=0.854, 42.6% vs 43.0% at 3 years) or RFS (P=0.653, 42.8% vs 35.9% at 3 years). In an adjusted model, age >50, cytogenetics and CR status were associated with inferior RFS (hazard ratio (HR)=2.16, P=0.003, HR=1.77, P=0.022, HR=2.47, P<0.001), whereas graft type was NS (HR=0.90, P=0.635). OS and RFS rates are similar in patients undergoing TCD or conventional HCT, but TCD effectively reduces the rate of GVHD. © 2015 Macmillan Publishers Limited.
Keywords: adult; cancer survival; treatment outcome; major clinical study; busulfan; fludarabine; dose response; methotrexate; drug megadose; disease association; etoposide; cyclophosphamide; melphalan; cancer mortality; thiotepa; acute lymphoblastic leukemia; acute graft versus host disease; chronic graft versus host disease; myeloablative conditioning; multicenter study; allogeneic hematopoietic stem cell transplantation; therapy effect; t cell depletion; tacrolimus; leukemia relapse; ex vivo study; clofarabine; thymocyte antibody; human; male; female; priority journal; article
Journal Title: Bone Marrow Transplantation
Volume: 50
Issue: 4
ISSN: 0268-3369
Publisher: Nature Publishing Group  
Date Published: 2015-04-01
Start Page: 493
End Page: 498
Language: English
DOI: 10.1038/bmt.2014.302
PROVIDER: scopus
PMCID: PMC4382422
PUBMED: 25621808
DOI/URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-84926422262&partnerID=40&md5=b0fef303af0e763f1ebbd3963228efee
Notes: Export Date: 4 May 2015 -- Source: Scopus
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MSK Authors
  1. Sergio Andres Giralt
    1050 Giralt
  2. Jenna Goldberg
    74 Goldberg
  3. Esperanza B Papadopoulos
    415 Papadopoulos
  4. Ann Jakubowski
    455 Jakubowski
  5. Miguel-Angel Perales
    913 Perales
  6. Richard O'Reilly
    747 O'Reilly
  7. Gabriela Soriano
    17 Soriano
  8. Sean McCarthy Devlin
    601 Devlin
  9. Patrick Dale Hilden
    108 Hilden
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