title: Evidence for a GVL effect following reduced-intensity allo-SCT in ALL: a British Society of Blood and Marrow Transplantation study.
abstract: Myeloablative allo-SCT decreases relapse incidence (RI) in ALL. Reduced intensity conditioning (RIC) may extend allo-SCT to older and less fit patients. Sixty-nine ALL patients reported to the BSBMT underwent fludarabine-based RIC allo-SCT, 38 from unrelated donors (UD). Forty-four patients received alemtuzumab. ALL was in CR in 64 patients (93%). This was a second or third SCT in 23 patients. Two-year OS and PFS were 36% and 32%, respectively. In multivariate analysis male recipients demonstrated better OS and PFS (hazard ratio (HR) = 0.42, P = 0.008 and HR = 0.45, P = 0.012, respectively). Two-year TRM was 29%: higher with younger age (HR = 0.97/year, P = 0.041), female recipient (HR = 2.55, P = 0.049) and increasing grade of acute GVHD (HR = 1.87, P = 0.001). Two-year RI was 38% and was lower in patients with acute and chronic GVHD (HR = 0.62 per increasing grade, P = 0.035 and HR = 0.52, P = 0.025, respectively). Long-term ALL-free survival is achievable following fludarabine-based RIC allo-SCT. The association between GVHD and decreased RI suggests the presence of a GVL effect.
authors: Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK.
authors: P G
authors: PG
authors: Medd
authors: A J
authors: AJ
authors: Peniket
authors: T J
authors: TJ
authors: Littlewood
authors: R
authors: R
authors: Pearce
authors: J
authors: J
authors: Perry
authors: K E
authors: KE
authors: Kirkland
authors: B E
authors: BE
authors: Shaw
authors: M N
authors: MN
authors: Potter
authors: C F
authors: CF
authors: Craddock
authors: D W
authors: DW
authors: Milligan
authors: A K
authors: AK
authors: Fielding
authors: D I
authors: DI
authors: Marks
authors: G
authors: G
authors: Cook
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000074323:Alemtuzumab; D064591:Allografts; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality / Q000628:therapy; D020544:Graft vs Leukemia Effect; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D012737:Sex Factors; D012955:Societies, Medical; D033581:Stem Cell Transplantation; D015996:Survival Rate; D019172:Transplantation Conditioning; D006113:United Kingdom; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000074323:Alemtuzumab; D014740:Vidarabine; C024352:fludarabine