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Bone Marrow Transplant. 2014 Mar;49(3):389-96. doi: 10.1038/bmt.2013.204. Epub 2014 Jan 13.

Impact of in vivo T-cell depletion on outcome of AML patients in first CR given peripheral blood stem cells and reduced-intensity conditioning allo-SCT from a HLA-identical sibling donor: a report from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation.

Author information

1
Department of Hematology, University of Liège, Liège, Belgium.
2
1] Clinical Hematology and Cellular Therapy Department, Hospital Saint Antoine, APHP, Paris, France [2] EBMT ALWP Office, Hospital Saint Antoine, Paris, France [3] Universite Pierre et Marie Curie, Paris, France [4] INSERM UMRs 938, Paris, France.
3
Hematology, CHU de Marseille, Marseille, France.
4
Hospital Clinico Universitario, Salamanca, Spain.
5
Hematology, CHU de Bordeaux, Bordeaux, France.
6
Centre for Clinical Haematology, Queen Elizabeth Hospital and School of Cancer Studies, University of Birmingham, Birmingham, UK.
7
Hematology, CHU de Toulouse, Toulouse, France.
8
Charles University Medical School and Teaching Hospital, Pilsen, Czech Republic.
9
BMT Unit, Department of Hematology, Hacettepe University, Ankara, Turkey.
10
Bone Marrow Transplantation, Saint-Louis Hospital, Paris, France.
11
Hematology, CHU de Nantes, Nantes, France.
12
Hope Directorate, St James's Hospital, Dublin, Ireland, UK.
13
Department of Hematology, University Hospital, Linköping, Sweden.
14
ICO-Hospital Duran i Reynals, l'Hospitalet de Llobregat, Barcelona, Spain.
15
Hematology Division, Sheba medical Center, Tel-Aviv University, Tel-Hashomer, Israel.

Abstract

The impact of in vivo T-cell depletion on transplantation outcomes in patients transplanted with reduced-intensity conditioning (RIC) remains controversial. This study assessed the outcome of 1250 adult patients with de novo AML in first CR (CR1) given PBSC from HLA-identical siblings after chemotherapy-based RIC. A total of 554 patients did not receive any form of in vivo T-cell depletion (control group), whereas antithymocyte globulin (ATG) and alemtuzumab were given in 444 and 252 patients, respectively. The incidences of grade II-IV acute GVHD were 21.4, 17.6 and 10.2% in control, ATG and alemtuzumab patients, respectively (P<0.001). In multivariate analysis, the use of ATG and the use of alemtuzumab were each associated with a lower risk of chronic GVHD (P<0.001 each), but a similar risk of relapse, and of nonrelapse mortality, and similar leukemia-free survival and OS. Further, among patients given BU-based RIC, the use of <6 mg/kg ATG did not increase the risk of relapse (hazard ratio, HR=1.1), whereas there was a suggestion for higher relapse risk in patients given 6 mg/kg ATG (HR=1.4, P=0.08). In summary, these data suggest that a certain amount of in vivo T-cell depletion can be safely used in the conditioning of AML patients in CR1 given PBSC after chemotherapy-based RIC.

PMID:
24419525
DOI:
10.1038/bmt.2013.204
[Indexed for MEDLINE]
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