T-cell depleted peripheral blood stem cell allotransplantation with T-cell add-back for patients with hematological malignancies: effect of chronic GVHD on outcome.
One hundred thirty-eight patients with hematologic malignancies received myeloablative T cell-depleted peripheral blood stem cell transplant (PBSCT) from an HLA-identical sibling donor. The T cell dose was adjusted to 0.2-1 x 10(5) CD3(+) cells/kg. The CD34 dose was 2.7-16 x 10(6)/kg. Patients with acute graft-versus-host disease (GVHD) grade <2 received 1 or 2 donor lymphocyte infusions of 10(7) CD3(+) cells/kg between days 45 and 100. Patients were designated according to relapse probability as standard or high relapse risk (77 and 61, respectively). Overall survival (OS), relapse-free survival, relapse, and transplant-related mortality (TRM) were 58%, 46%, 40%, and 20%, respectively, after a median follow-up of 4 years. Fifty-three (39%) and 21 (15%) patients developed grade 2-4 and 3-4 acute GVHD. Forty-two (36%) had limited and 29 (25%) had extensive chronic GVHD. In multivariate analysis, disease risk was an independent factor for OS and relapse, day-30 lymphocyte count for OS and TRM, and chronic GVHD for OS and relapse. PBSCT with early T cell add back leads to comparable rates of chronic GVHD compared with T cell-replete PBSCT. However, this chronic GVHD after T cell add back is associated with less mortality and retains a protective effect in terms of relapse, at least in the standard-risk patients.
Montero
Aldemar
A
Stem Cell Allotransplantation Section, Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland 20892-1202, USA.
Savani
Bipin N
BN
Shenoy
Aarthi
A
Read
Elizabeth J
EJ
Carter
Charles S
CS
Leitman
Susan F
SF
Mielke
Stephan
S
Rezvani
Katayoun
K
Childs
Richard
R
Barrett
A John
AJ
D000293:Adolescent; D000328:Adult; D002648:Child; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology* / Q000401:mortality; D020544:Graft vs Leukemia Effect; D019337:Hematologic Neoplasms / Q000401:mortality / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007239:Infections / Q000209:etiology / Q000401:mortality; D047589:Leukocyte Reduction Procedures; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality / Q000601:surgery; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011654:Pulmonary Edema / Q000209:etiology / Q000401:mortality; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D013601:T-Lymphocytes / Q000637:transplantation*; D014184:Transplantation, Homologous / Q000009:adverse effects*; D016896:Treatment Outcome