title: T-cell depletion of bone marrow transplants for leukemia from donors other than HLA-identical siblings: advantage of T-cell antibodies with narrow specificities.
abstract: T-cell depletion of donor marrow decreases graft-versus-host disease resulting from transplants from unrelated and human leukocyte antigen (HLA)-mismatched related donors. However, there are diverse strategies for T-cell-depleted transplantation, and it is uncertain whether any improve leukemia-free survival (LFS). To compare strategies for T-cell-depleted alternative donor transplants and to compare T-cell depleted with non-T-cell-depleted transplants, we studied 870 patients with leukemia who received T-cell-depleted transplants from unrelated or HLA-mismatched related donors from 1982 to 1994. Outcomes were compared with those of 998 non-T-cell-depleted transplants. We compared LFS using different strategies for T-cell-depleted transplantation considering T-cell depletion technique, intensity of pretransplant conditioning, and posttransplant immune suppression using proportional hazards regression to adjust for other prognostic variables. Five categories of T-cell depletion techniques were considered: narrow-specificity antibodies, broad-specificity antibodies, Campath antibodies, elutriation, and lectins. Strategies resulting in similar LFS were pooled to compare T-cell-depleted with non-T-cell-depleted transplants. Recipients of transplants T-cell depleted by narrow-specificity antibodies had lower treatment failure risk (higher LFS) than recipients of transplants T-cell depleted by other techniques. Compared with non-T-cell-depleted transplants (5-year probability +/- 95% confidence interval [CI] of LFS, 31% +/- 4%), 5-year LFS was 29% +/- 5% (P = NS) after transplants T-cell depleted by narrow-specificity antibodies and 16% +/- 4% (P <.0001) after transplants T-cell depleted by other techniques. After alternative donor transplantation, T-cell depletion of donor marrow by narrow-specificity antibodies resulted in LFS rates that were higher than those for transplants T-cell depleted using other techniques but similar to those for non-T-cell-depleted transplants. (Blood. 2000;95:3996-4003)
authors.affiliation: International Bone Marrow Transplant Registry, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Champlin
authors.forename: J R
authors.initials: JR
authors.lastname: Passweg
authors.forename: M J
authors.initials: MJ
authors.lastname: Zhang
authors.forename: P A
authors.initials: PA
authors.lastname: Rowlings
authors.forename: C J
authors.initials: CJ
authors.lastname: Pelz
authors.forename: K A
authors.initials: KA
authors.lastname: Atkinson
authors.forename: A J
authors.initials: AJ
authors.lastname: Barrett
authors.forename: J Y
authors.initials: JY
authors.lastname: Cahn
authors.forename: W R
authors.initials: WR
authors.lastname: Drobyski
authors.forename: R P
authors.initials: RP
authors.lastname: Gale
authors.forename: J M
authors.initials: JM
authors.lastname: Goldman
authors.forename: A
authors.initials: A
authors.lastname: Gratwohl
authors.forename: E C
authors.initials: EC
authors.lastname: Gordon-Smith
authors.forename: P J
authors.initials: PJ
authors.lastname: Henslee-Downey
authors.forename: R H
authors.initials: RH
authors.lastname: Herzig
authors.forename: J P
authors.initials: JP
authors.lastname: Klein
authors.forename: A M
authors.initials: AM
authors.lastname: Marmont
authors.forename: R J
authors.initials: RJ
authors.lastname: O'Reilly
authors.forename: O
authors.initials: O
authors.lastname: Ringdén
authors.forename: S
authors.initials: S
authors.lastname: Slavin
authors.forename: K A
authors.initials: KA
authors.lastname: Sobocinski
authors.forename: B
authors.initials: B
authors.lastname: Speck
authors.forename: R S
authors.initials: RS
authors.lastname: Weiner
authors.forename: M M
authors.initials: MM
authors.lastname: Horowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000918:Antibody Specificity; D016026:Bone Marrow Transplantation / Q000276:immunology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000627:therapeutic use; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007518:Isoantibodies / Q000276:immunology; D007938:Leukemia / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D008212:Lymphocyte Depletion; D008875:Middle Aged; D009679:Nuclear Family; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D013601:T-Lymphocytes / Q000276:immunology*; D014019:Tissue Donors; D014184:Transplantation, Homologous
chemical_list: D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D016572:Cyclosporine