Clinical impact of human Jurkat T-cell-line-derived antithymocyte globulin in multiple myeloma patients undergoing allogeneic stem cell transplantation.
BACKGROUND
Antithymocyte globulin or human Jurkat T-cell-line-derived antilymphocyte globulin is used in allogeneic stem cell transplantation to induce in vivo T-cell depletion to facilitate engraftment and lower graft-versus-host disease. In vitro studies suggest that antithymocyte globulin, besides causing T-cell depletion, has strong anti-myeloma activity.


METHODS
We evaluated the anti-myeloma activity of antilymphocyte globulin in a melphalan/fludarabine-based reduced intensity conditioning regimen as well as the incidence of graft-versus-host disease in 138 multiple myeloma patients who underwent allogeneic stem cell transplantation with (n=79) or without (n=59) antilymphocyte globulin.


RESULTS
Leukocyte and platelet engraftment were faster in the group not receiving antilymphocyte globulin (13 vs. 16 days, p<0.001 and 11 vs. 19 days, p< 0.001, respectively). Inclusion of antithymocyte globulin led to a better day 100 overall response rate (93% vs. 78%, p=0.03) and complete response rate (59% vs. 39%, p=0.04), to a lower incidence of both acute grade III/IV graft-versus-host-disease (11% vs. 22%, p=0.10) and chronic graft-versus-host disease (23% vs. 65%, p<0.001) and to a trend to improved event-free survival at 3 years (39% vs. 27%, p=0.5). There was no difference in the estimated cumulative incidence of treatment-related mortality at 1 year between the groups receiving or not antilymphocyte globulin (25% vs. 26%). In a multivariate analysis treatment with antilymphocyte globulin was the only significant factor for achievement of a complete remission (RR:2.57, p=0.02).


CONCLUSIONS
Inclusion of antithymocyte globulin in allogeneic stem cell transplantation protocols for patients with multiple myeloma may increase remission rates and at the same time prevent graft-versus-host disease with no increase of relapses.
Ayuk
Francis
F
Dept of Stem cell Transplantation, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.
Perez-Simon
José A
JA
Shimoni
Avichai
A
Sureda
Anna
A
Zabelina
Tatjana
T
Schwerdtfeger
Rainer
R
Martino
Rodrigo
R
Sayer
Herbert Gottfried
HG
Alegre
Adrián
A
Lahuerta
Juan-José
JJ
Atanackovic
Djordje
D
Wolschke
Christine
C
Nagler
Arnon
A
Zander
Axel R
AR
San Miguel
Jesús F
JF
Kröger
Nicolaus
N
D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000097:blood*; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease; D006801:Humans; D019169:Jurkat Cells; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D012008:Recurrence; D035781:Siblings; D033581:Stem Cell Transplantation; D015996:Survival Rate; D014184:Transplantation, Homologous
D000961:Antilymphocyte Serum