title: TcRαβ-depleted haploidentical transplantation results in adult acute leukemia patients.
abstract: BACKGROUND
  The use of αβ+ T-cell-depleted grafts is a novel approach to prevent graft failure, graft-versus-host disease (GVHD), and non-relapse mortality (NRM) in patients undergoing haploidentical hematopoietic stem cell transplantation.
  
  
  METHODS
  Thirty-four patients with acute leukemia and lacking a match donor were treated with αβ T-cell-depleted allografts from haploidentical family donors. A total of 24 patients had acute myeloid leukemia (AML) and 10 had acute lymphoblastic leukemia. 84.4% of patients were in the high-risk group, and 55.9% were not in remission. The preparative regimen included thiotepa, melphalan, fludarabine, and anti-thymocyte globulin-Fresenius. Grafts were peripheral blood stem cells engineered by TcR-alpha/beta depletion.
  
  
  RESULTS
  Neutrophil and platelet engraftment was achieved on days +12 (range, 10.5-15) and +11 (range, 10-12). All but three patients were engrafted with full donor chimerism. Grade III-IV acute GVHD occurred in two (5.9%) patients and chronic GVHD in two (6.1%). Disease-free survival and overall survival were 42 and 54% at 1 year, respectively. AML as disease type (HR: 4.87, 95% CI: 1.50-15.87) and mother as donor (HR: 1.05, 95% CI: 1.00-1.11) were found to be independent risk factors on patient survival. Mortality and NRM in the first 100 days were 5 of 34 (14.7%) and 4 of 34 (11.7%). Relapse was the main cause of death (56.3%). T-cell reconstitution appears to be faster than that reported in published data with CD3/CD19-depleted grafts.
  
  
  CONCLUSIONS
  αβ T-cell-depleted haploidentical transplantation may be a good alternative for high-risk patients if there are no human leukocyte antigen matched donors.
authors.affiliation: a Hematology Department, Medical Faculty , Erciyes University , Kayseri , Turkey.
authors.forename: Leylagul
authors.initials: L
authors.lastname: Kaynar
authors.affiliation: a Hematology Department, Medical Faculty , Erciyes University , Kayseri , Turkey.
authors.forename: Koray
authors.initials: K
authors.lastname: Demir
authors.affiliation: a Hematology Department, Medical Faculty , Erciyes University , Kayseri , Turkey.
authors.forename: Esra Ermiş
authors.initials: EE
authors.lastname: Turak
authors.affiliation: a Hematology Department, Medical Faculty , Erciyes University , Kayseri , Turkey.|b Dışkapı Yıldırım Beyazıt Training and Research Hospital , Ankara , Turkey.
authors.forename: Çiğdem Pala
authors.initials: ÇP
authors.lastname: Öztürk
authors.affiliation: c Biostatistics Department, Medical Faculty , Erciyes University , Kayseri , Turkey.
authors.forename: Gökmen
authors.initials: G
authors.lastname: Zararsız
authors.affiliation: d Genome and Stem Cell Center (GENKOK) , Erciyes University , Kayseri , Turkey.
authors.forename: Zeynep Burçin
authors.initials: ZB
authors.lastname: Gönen
authors.affiliation: e Microbiology Department, Medical Faculty , Erciyes University , Kayseri , Turkey.
authors.forename: Selma
authors.initials: S
authors.lastname: Gökahmetoğlu
authors.affiliation: a Hematology Department, Medical Faculty , Erciyes University , Kayseri , Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Şıvgın
authors.affiliation: a Hematology Department, Medical Faculty , Erciyes University , Kayseri , Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Eser
authors.affiliation: f Immunology Department, Medical Faculty , Erciyes University , Kayseri , Turkey.
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Köker
authors.affiliation: a Hematology Department, Medical Faculty , Erciyes University , Kayseri , Turkey.
authors.forename: Musa
authors.initials: M
authors.lastname: Solmaz
authors.affiliation: a Hematology Department, Medical Faculty , Erciyes University , Kayseri , Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Ünal
authors.affiliation: a Hematology Department, Medical Faculty , Erciyes University , Kayseri , Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Çetin
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control; D006680:HLA Antigens / Q000235:genetics* / Q000276:immunology; D006239:Haplotypes; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007938:Leukemia / Q000235:genetics* / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D015470:Leukemia, Myeloid, Acute / Q000235:genetics / Q000276:immunology / Q000401:mortality / Q000628:therapy; D008212:Lymphocyte Depletion / Q000379:methods; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000235:genetics / Q000276:immunology / Q000401:mortality / Q000628:therapy; D016693:Receptors, Antigen, T-Cell, alpha-beta / Q000378:metabolism*; D012189:Retrospective Studies; D016019:Survival Analysis; D016176:T-Lymphocyte Subsets / Q000276:immunology / Q000378:metabolism*; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006680:HLA Antigens; D016693:Receptors, Antigen, T-Cell, alpha-beta
keywords: haploidentical transplantation; immune reconstitution; αβ T cell depletion