T-cell depletion of bone marrow transplants for leukemia from donors other than HLA-identical siblings: advantage of T-cell antibodies with narrow specificities.
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)
Champlin
R E
RE
International Bone Marrow Transplant Registry, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Passweg
J R
JR
Zhang
M J
MJ
Rowlings
P A
PA
Pelz
C J
CJ
Atkinson
K A
KA
Barrett
A J
AJ
Cahn
J Y
JY
Drobyski
W R
WR
Gale
R P
RP
Goldman
J M
JM
Gratwohl
A
A
Gordon-Smith
E C
EC
Henslee-Downey
P J
PJ
Herzig
R H
RH
Klein
J P
JP
Marmont
A M
AM
O'Reilly
R J
RJ
Ringdén
O
O
Slavin
S
S
Sobocinski
K A
KA
Speck
B
B
Weiner
R S
RS
Horowitz
M M
MM
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
D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D016572:Cyclosporine