title: Stable mixed chimerism after T cell-depleted allogeneic hematopoietic stem cell transplantation using conditioning with low-dose total body irradiation and fludarabine.
abstract: Although reduced intensity conditioning (RIC) before allografting is associated with low treatment-related morbidity and mortality, graft-versus-host disease (GVHD) remains a significant complication of hematopoietic stem cell transplantation (HSCT). T cell depletion (TCD) has been successfully used in conventional allotransplantation to reduce the incidence of GVHD, but was associated with an increased rate of engraftment failure. In a small cohort of six patients at high risk of developing GVHD we have determined whether sustained engraftment could be achieved using reduced intensity conditioning and T cell depletion in combination. All patients engrafted and 5/6 developed high levels (i.e. > or =95%) of donor chimerism, even though mismatched related or matched unrelated donors were used. Only one patient developed acute GVHD, as he received donor lymphocyte infusions (DLI) for relapse. In summary, TCD might be a useful prophylactic tool in RIC allogeneic HSCT. Although TCD after RIC might be associated with high relapse rate, as 5/6 patients are not in remission, this combined strategy might be appropriate for patients with less aggressive malignant or non-malignant diseases in which high transplant-related morbidity and mortality is not acceptable.
authors.affiliation: Department of Haematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Görner
authors.forename: L
authors.initials: L
authors.lastname: Kordelas
authors.forename: M
authors.initials: M
authors.lastname: Thalheimer
authors.forename: T
authors.initials: T
authors.lastname: Luft
authors.forename: S
authors.initials: S
authors.lastname: Pfeiffer
authors.forename: F
authors.initials: F
authors.lastname: Ustaoglu
authors.forename: M
authors.initials: M
authors.lastname: Punzel
authors.forename: R
authors.initials: R
authors.lastname: Weber-Nordt
authors.forename: M
authors.initials: M
authors.lastname: Moos
authors.forename: H
authors.initials: H
authors.lastname: Goldschmidt
authors.forename: A D
authors.initials: AD
authors.lastname: Ho
mesh_terms: D000328:Adult; D015331:Cohort Studies; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008212:Lymphocyte Depletion; D017710:Lymphocyte Transfusion; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D014019:Tissue Donors; D018183:Transplantation Chimera; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use*; D014916:Whole-Body Irradiation
chemical_list: D014740:Vidarabine; C024352:fludarabine