title: Low-dose alemtuzumab for GvHD prevention followed by prophylactic donor lymphocyte infusions in high-risk leukemia.
abstract: We analyzed the use of low-dose alemtuzumab in a cohort of 158 consecutive patients who underwent allogeneic PBSC transplantation. Patients with high-risk acute leukemia were prospectively screened for prophylactic donor lymphocyte infusion (pDLI). Lymphocytes were administered repeatedly at low and non-escalating doses (0.5-1 × 106/kg). Low-dose alemtuzumab was effective in prevention of acute GvHD after sibling or well-matched unrelated transplantation, whereas a more intensified approach was needed after mismatched transplantation. The cumulative incidence of chronic moderate/severe chronic-GvHD (cGvHD) was 15.6%. In total, 63 high-risk leukemia patients were eligible for pDLI. Only 1 out of the 39 pDLI recipients relapsed as compared with 7 out of the 24 recipients, who did not receive pDLI due to logistical hurdles. In multivariate analysis, the use of adjuvant lymphocyte therapy was significantly associated with reduced incidence of relapse and improved disease-free survival. In summary, low-dose alemtuzumab confers to a low cGvHD incidence and the administration of pDLIs in this context is very likely to reduce relapse risk in high risk leukemia patients. This is translated in an estimated 5-year probability of GvHD-free and relapse-free survival of 43.3% for the 136 leukemia patients.
authors.affiliation: BMT Unit, Department of Internal Medicine, 'Attikon' University Hospital of Athens, Athens, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Tsirigotis
authors.affiliation: BMT Unit, Department of Internal Medicine, University Hospital of Patras, Rio, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Liga
authors.affiliation: BMT Unit, Department of Internal Medicine, 'Attikon' University Hospital of Athens, Athens, Greece.
authors.forename: K
authors.initials: K
authors.lastname: Gkirkas
authors.affiliation: BMT Unit, Department of Internal Medicine, 'Attikon' University Hospital of Athens, Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Stamouli
authors.affiliation: BMT Unit, Department of Internal Medicine, University Hospital of Patras, Rio, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Triantafyllou
authors.affiliation: BMT Unit, Department of Internal Medicine, University Hospital of Patras, Rio, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Marangos
authors.affiliation: BMT Unit, Department of Internal Medicine, 'Attikon' University Hospital of Athens, Athens, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Pessach
authors.affiliation: BMT Unit, Department of Internal Medicine, University Hospital of Patras, Rio, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Sarantopoulos
authors.affiliation: BMT Unit, Department of Internal Medicine, University Hospital of Patras, Rio, Greece.
authors.forename: N
authors.initials: N
authors.lastname: Spyridis
authors.affiliation: BMT Unit, Department of Internal Medicine, University Hospital of Patras, Rio, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Spyridonidis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000074323:Alemtuzumab / Q000008:administration & dosage*; D064591:Allografts; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007938:Leukemia / Q000401:mortality / Q000628:therapy; D017710:Lymphocyte Transfusion; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D035781:Siblings; D015996:Survival Rate; D013997:Time Factors; D061349:Unrelated Donors
chemical_list: D000074323:Alemtuzumab