Marrow transplantation from HLA non-identical family donors for the treatment of leukaemia: a pilot study of 15 patients using additional immunosuppression and T-cell depletion.
Fifteen patients with high-risk leukaemia were given T-cell depleted marrow transplants from HLA non-identical related donors. They were treated with a combination of total body irradiation (TBI), high-dose cytosine arabinoside (Ara-C) and high-dose melphalan in an attempt to prevent a host-versus-graft reaction. Antilymphocyte globulins were given prior to transplantation for additional immunosuppression to 13 patients and in-vivo monoclonal antibody anti-human LFA1 to two. Engraftment and chimaerism assessed by HLA typing were achieved in 14 patients. Seven developed acute graft-versus-host disease (two fatal), one failed to engraft. Six patients died in complete remission from cytomegalovirus (CMV) interstitial pneumonitis and three remain alive in complete remission 2, 3 and 13 months after transplant. We conclude that aggressive immunosuppression allows for sustained engraftment of T-cell depleted HLA non-identical marrow. The incidence and severity of GVHD are acceptable and CMV pneumonitis remains the major problem.
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D002469:Cell Separation; D002648:Child; D002675:Child, Preschool; D005190:Family; D005260:Female; D006680:HLA Antigens / Q000032:analysis*; D006801:Humans; D007165:Immunosuppression Therapy; D007938:Leukemia / Q000628:therapy*; D008297:Male; D010865:Pilot Projects; D013601:T-Lymphocytes; D014019:Tissue Donors
D006680:HLA Antigens