Transplantation of T-lymphocyte depleted marrow with an addback of T cells.
Depletion of T-lymphocytes from allogeneic marrow prior to transplantation decreases the risk of serious graft versus host disease (GvHD), but also increases the risk of relapse. We have used a partial T-cell depletion technique, in the hope of controlling GvHD without compromising relapse risk. Allogeneic marrow was fully T-cell depleted ex vivo with Campath 1M, and infused together with an 'addback' of 2 x 10(5) donor peripheral blood T-cells/kg in 16 consecutive patients undergoing BMT from HLA-identical family members. Post-transplant immunosuppression was with cyclosporin A in conventional dosage. Eight cases developed grade I or II GvHD, limited to the skin in all cases. Only the two grade II cases required steroid therapy; the remainder were easily controlled with simple emollients. No cases of more advanced GvHD were seen. All patients engrafted promptly. With a median follow-up for the survivors of 976 days, seven cases have relapsed, with an overall projected actuarial disease-free survival of 37.5 per cent at 36 months. The overall outcome (good control of GvHD but high relapse rate) is therefore similar to that expected in patients receiving fully T-depleted marrow without post-transplant immunosuppression.
Clark
R E
RE
University Department of Haematology, Royal Liverpool University Hospital, U.K.
Pender
N
N
D000328:Adult; D000906:Antibodies; D015703:Antigens, CD / Q000276:immunology; D000951:Antigens, Neoplasm; D016465:Bone Marrow Purging; D016026:Bone Marrow Transplantation; D000074301:CD52 Antigen; D005260:Female; D005500:Follow-Up Studies; D006023:Glycoproteins; D006084:Graft Rejection; D006086:Graft vs Host Disease / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013601:T-Lymphocytes / Q000276:immunology / Q000473:pathology*; D014184:Transplantation, Homologous
D000906:Antibodies; D015703:Antigens, CD; D000951:Antigens, Neoplasm; D000074301:CD52 Antigen; C000613862:CD52 protein, human; D006023:Glycoproteins