title: Ex vivo T cell-depleted versus unmodified allografts in patients with acute myeloid leukemia in first complete remission.
abstract: This study was conducted to retrospectively compare the clinical outcomes after transplantation of T cell-depleted (TCD) and unmodified allografts in patients with acute myeloid leukemia (AML) in first complete remission (CR1). Patients received TCD grafts at Memorial Sloan-Kettering Cancer Center (MSKCC, N = 115) between 2001 and 2010 using the following preparative regimens: hyperfractionated total body irradiation (HFTBI)+thiotepa+fludarabine; HFTBI+thiotepa+cyclophosphamide; or i.v. busulfan+melphalan+fludarabine. TCD was performed by 1 of 2 immunomagnetic CD34(+) cell selection methods for peripheral blood grafts or by soybean lectin agglutination followed by sheep red blood cell-rosette depletion for bone marrow grafts. No additional graft-versus-host disease (GVHD) prophylaxis was administered. Patients received unmodified grafts at M.D. Anderson Cancer Center (MDACC, N = 181) after conditioning with busulfan+fludarabine and GVHD prophylaxis with tacrolimus+mini-methotrexate. Patients with unrelated or human leukocyte antigen-mismatched donors received anti-thymocyte globulin (ATG) at both centers, with some recipients of matched related donor TCD transplants also receiving ATG, depending upon the preparative regimen. TCD graft recipients were more likely to be older, receive a mismatched transplant, and have peripheral blood used as the graft source. The incidences rates of grades 2 to 4 acute GVHD and chronic GVHD were significantly lower in the TCD graft group (5% versus 18%, and 13% versus 53%). Three-year relapse-free and overall survival rates were 58% and 57%, respectively, in recipients of TCD grafts, and 60% and 66% in recipients of unmodified grafts (P = not significant). Survival and relapse-free survival are similar after TCD and conventional transplants from related/unrelated donors in patients with AML in CR1, but TCD significantly reduces GVHD.
authors: Department of Stem Cell Transplantation and Cellular Therapy, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors: Ulas D
authors: UD
authors: Bayraktar
authors: Marcos
authors: M
authors: de Lima
authors: Rima M
authors: RM
authors: Saliba
authors: Molly
authors: M
authors: Maloy
authors: Hugo R
authors: HR
authors: Castro-Malaspina
authors: Julianne
authors: J
authors: Chen
authors: Gabriela
authors: G
authors: Rondon
authors: Alexander
authors: A
authors: Chiattone
authors: Ann A
authors: AA
authors: Jakubowski
authors: Farid
authors: F
authors: Boulad
authors: Nancy A
authors: NA
authors: Kernan
authors: Richard J
authors: RJ
authors: O'Reilly
authors: Richard E
authors: RE
authors: Champlin
authors: Sergio
authors: S
authors: Giralt
authors: Borje S
authors: BS
authors: Andersson
authors: Esperanza B
authors: EB
authors: Papadopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols; D016026:Bone Marrow Transplantation; D002066:Busulfan / Q000008:administration & dosage; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008212:Lymphocyte Depletion; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D013601:T-Lymphocytes / Q000276:immunology* / Q000473:pathology; D013852:Thiotepa / Q000008:administration & dosage; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D000961:Antilymphocyte Serum; D013852:Thiotepa; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine; D008558:Melphalan