title: Post-transplant T cell chimerism predicts graft versus host disease but not disease relapse in patients undergoing an alemtuzumab based reduced intensity conditioned allogeneic transplant.
abstract: In this multicentre retrospective study we have studied the impact of T cell chimerism on the outcome of 133 patients undergoing an alemtuzumab based reduced intensity conditioning allograft (RIC). The median age of the patients was 50 years (range 42-55 years). 77 patients were transplanted using an HLA identical sibling donor while 56 patients received a fully matched volunteer unrelated donor graft. 64 patients had a lymphoid malignancy and 69 were transplanted for a myeloid malignancy. 38 patients (29%) relapsed with no significant difference in risk of relapse between patients developing full donor and mixed donor chimerism in the T-cell compartment on D+90 and D+180 post transplant. Day 90 full donor T cell chimerism correlated with an increased incidence of acute GVHD according to NIH criteria (p=0.0004) and the subsequent development of chronic GVHD. Consistent with previous observations, our results confirmed a correlation between the establishment of T cell full donor chimerism and acute GVHD in T deplete RIC allografts. However our study failed to identify any correlation between T cell chimerism and relapse risk and challenge the use of pre-emptive donor lymphocyte infusions (DLI) in patients with mixed T cell chimerism transplanted using an alemtuzumab based RIC regimen.
authors: Department of Haematology, Heart of England NHS Foundation Trust, Birmingham, UK. emelni@hotmail.com
authors: E
authors: E
authors: Nikolousis
authors: S
authors: S
authors: Robinson
authors: S
authors: S
authors: Nagra
authors: C
authors: C
authors: Brookes
authors: F
authors: F
authors: Kinsella
authors: S
authors: S
authors: Tauro
authors: S
authors: S
authors: Jeffries
authors: M
authors: M
authors: Griffiths
authors: P
authors: P
authors: Mahendra
authors: M
authors: M
authors: Cook
authors: S
authors: S
authors: Paneesha
authors: R
authors: R
authors: Lovell
authors: B
authors: B
authors: Kishore
authors: S
authors: S
authors: Chaganti
authors: R
authors: R
authors: Malladi
authors: M
authors: M
authors: Raghavan
authors: P
authors: P
authors: Moss
authors: D
authors: D
authors: Milligan
authors: C
authors: C
authors: Craddock
mesh_terms: D000328:Adult; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002908:Chronic Disease; D006086:Graft vs Host Disease / Q000209:etiology* / Q000628:therapy; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D035781:Siblings; D033581:Stem Cell Transplantation; D013601:T-Lymphocytes; D018183:Transplantation Chimera; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000074323:Alemtuzumab