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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.

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Department of Hematology, University of Liège, Liège, Belgium.
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.
Hematology, CHU de Marseille, Marseille, France.
Hospital Clinico Universitario, Salamanca, Spain.
Hematology, CHU de Bordeaux, Bordeaux, France.
Centre for Clinical Haematology, Queen Elizabeth Hospital and School of Cancer Studies, University of Birmingham, Birmingham, UK.
Hematology, CHU de Toulouse, Toulouse, France.
Charles University Medical School and Teaching Hospital, Pilsen, Czech Republic.
BMT Unit, Department of Hematology, Hacettepe University, Ankara, Turkey.
Bone Marrow Transplantation, Saint-Louis Hospital, Paris, France.
Hematology, CHU de Nantes, Nantes, France.
Hope Directorate, St James's Hospital, Dublin, Ireland, UK.
Department of Hematology, University Hospital, Linköping, Sweden.
ICO-Hospital Duran i Reynals, l'Hospitalet de Llobregat, Barcelona, Spain.
Hematology Division, Sheba medical Center, Tel-Aviv University, Tel-Hashomer, Israel.


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.

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