title: Prevention of graft-versus-host disease by ex vivo T cell depletion: reduction in graft failure with augmented total body irradiation.
abstract: Graft-versus-host disease prevention was attempted in 35 consecutive patients with hematological malignancy who received bone marrow from an HLA match sibling donor who was depleted of T cells ex vivo. Five of the first 8 patients who received cyclophosphamide 60 mg/kg on 2 consecutive days followed by fractionated total body irradiation (TBI) (6 x 2 Gy) had graft failure. The subsequent 27 patients had received an extra fraction of TBI (7 x 2 Gy), and only one failed to have stable engraftment. There were no differences in nucleated cell dose, granulocyte-macrophage colony-forming units, or T cell numbers given to the two groups. Neutrophil but not platelet regeneration of those patients who successfully grafted was slower than in a group of historical controls receiving unmanipulated marrow. Significant graft-versus-host disease was prevented with no increase in relapse rate. We suggest that engraftment can be reliably achieved by augmenting the TBI conditioning in recipients of T cell-depleted matched allogeneic bone marrow.
authors.affiliation: Department of Haematology, Glasgow Royal Infirmary, U.K.
authors.forename: A K
authors.initials: AK
authors.lastname: Burnett
authors.forename: I M
authors.initials: IM
authors.lastname: Hann
authors.forename: A G
authors.initials: AG
authors.lastname: Robertson
authors.forename: M
authors.initials: M
authors.lastname: Alcorn
authors.forename: B
authors.initials: B
authors.lastname: Gibson
authors.forename: I
authors.initials: I
authors.lastname: McVicar
authors.forename: L
authors.initials: L
authors.lastname: Niven
authors.forename: S
authors.initials: S
authors.lastname: Mackinnon
authors.forename: H
authors.initials: H
authors.lastname: Hambley
authors.forename: A
authors.initials: A
authors.lastname: Morrison
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D006084:Graft Rejection; D006086:Graft vs Host Disease / Q000276:immunology / Q000517:prevention & control*; D006680:HLA Antigens / Q000032:analysis; D006801:Humans; D008212:Lymphocyte Depletion; D013601:T-Lymphocytes; D014916:Whole-Body Irradiation
chemical_list: D006680:HLA Antigens