title: Impact of in vivo T-cell depletion on outcome of AML patients in first CR given peripheral blood stem cells and reduced-intensity conditioning allo-SCT from a HLA-identical sibling donor: a report from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation.
abstract: The impact of in vivo T-cell depletion on transplantation outcomes in patients transplanted with reduced-intensity conditioning (RIC) remains controversial. This study assessed the outcome of 1250 adult patients with de novo AML in first CR (CR1) given PBSC from HLA-identical siblings after chemotherapy-based RIC. A total of 554 patients did not receive any form of in vivo T-cell depletion (control group), whereas antithymocyte globulin (ATG) and alemtuzumab were given in 444 and 252 patients, respectively. The incidences of grade II-IV acute GVHD were 21.4, 17.6 and 10.2% in control, ATG and alemtuzumab patients, respectively (P<0.001). In multivariate analysis, the use of ATG and the use of alemtuzumab were each associated with a lower risk of chronic GVHD (P<0.001 each), but a similar risk of relapse, and of nonrelapse mortality, and similar leukemia-free survival and OS. Further, among patients given BU-based RIC, the use of <6 mg/kg ATG did not increase the risk of relapse (hazard ratio, HR=1.1), whereas there was a suggestion for higher relapse risk in patients given 6 mg/kg ATG (HR=1.4, P=0.08). In summary, these data suggest that a certain amount of in vivo T-cell depletion can be safely used in the conditioning of AML patients in CR1 given PBSC after chemotherapy-based RIC.
authors.affiliation: Department of Hematology, University of Liège, Liège, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Baron
authors.affiliation: 1] Clinical Hematology and Cellular Therapy Department, Hospital Saint Antoine, APHP, Paris, France [2] EBMT ALWP Office, Hospital Saint Antoine, Paris, France [3] Universite Pierre et Marie Curie, Paris, France [4] INSERM UMRs 938, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Labopin
authors.affiliation: Hematology, CHU de Marseille, Marseille, France.
authors.forename: D
authors.initials: D
authors.lastname: Blaise
authors.affiliation: Hospital Clinico Universitario, Salamanca, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Lopez-Corral
authors.affiliation: Hematology, CHU de Bordeaux, Bordeaux, France.
authors.forename: S
authors.initials: S
authors.lastname: Vigouroux
authors.affiliation: Centre for Clinical Haematology, Queen Elizabeth Hospital and School of Cancer Studies, University of Birmingham, Birmingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: Craddock
authors.affiliation: Hematology, CHU de Toulouse, Toulouse, France.
authors.forename: M
authors.initials: M
authors.lastname: Attal
authors.affiliation: Charles University Medical School and Teaching Hospital, Pilsen, Czech Republic.
authors.forename: P
authors.initials: P
authors.lastname: Jindra
authors.affiliation: BMT Unit, Department of Hematology, Hacettepe University, Ankara, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Goker
authors.affiliation: Bone Marrow Transplantation, Saint-Louis Hospital, Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Socié
authors.affiliation: Hematology, CHU de Nantes, Nantes, France.
authors.forename: P
authors.initials: P
authors.lastname: Chevallier
authors.affiliation: Hope Directorate, St James's Hospital, Dublin, Ireland, UK.
authors.forename: P
authors.initials: P
authors.lastname: Browne
authors.affiliation: Department of Hematology, University Hospital, Linköping, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Sandstedt
authors.affiliation: ICO-Hospital Duran i Reynals, l'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: R F
authors.initials: RF
authors.lastname: Duarte
authors.affiliation: Hematology Division, Sheba medical Center, Tel-Aviv University, Tel-Hashomer, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Nagler
authors.affiliation: 1] Clinical Hematology and Cellular Therapy Department, Hospital Saint Antoine, APHP, Paris, France [2] EBMT ALWP Office, Hospital Saint Antoine, Paris, France [3] Universite Pierre et Marie Curie, Paris, France [4] INSERM UMRs 938, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Mohty
mesh_terms: D000328:Adult; D000368:Aged; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000378:metabolism; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D006086:Graft vs Host Disease; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000097:blood* / Q000628:therapy*; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D035781:Siblings; D013234:Stem Cells / Q000166:cytology*; D013601:T-Lymphocytes / Q000166:cytology*; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000961:Antilymphocyte Serum; D006680:HLA Antigens; D000074323:Alemtuzumab; D008558:Melphalan