Impact of immune modulation with in vivo T-cell depletion and myleoablative total body irradiation conditioning on outcomes after unrelated donor transplantation for childhood acute lymphoblastic leukemia.

Blood
P VeysMary Eapen

Abstract

To determine whether in vivo T-cell depletion, which lowers GVHD, abrogates the antileukemic benefits of myeloablative total body irradiation-based conditioning and unrelated donor transplantation, in the present study, we analyzed 715 children with acute lymphoblastic leukemia. Patients were grouped for analysis according to whether conditioning included antithymocyte globulin (ATG; n = 191) or alemtuzumab (n = 132) and no in vivo T-cell depletion (n = 392). The median follow-up time was 3.5 years for the ATG group and 5 years for the alemtuzumab and T cell-replete groups. Using Cox regression analysis, we compared transplantation outcomes between groups. Compared with no T-cell depletion, grade 2-4 acute and chronic GVHD rates were significantly lower after in vivo T-cell depletion with ATG (relative risk [RR] = 0.66; P = .005 and RR = 0.55; P < .0001, respectively) or alemtuzumab (RR = 0.09; P < .003 and RR = 0.21; P < .0001, respectively). Despite lower GVHD rates after in vivo T-cell depletion, nonrelapse mortality, relapse, overall survival, and leukemia-free survival (LFS) did not differ significantly among the treatment groups. The 3-year probabilities of LFS after ATG-containing, alemtuzumab-containing, and T cell-repl...Continue Reading

References

Nov 30, 1999·Hematology/oncology Clinics of North America·M E FlowersK M Sullivan
Apr 24, 2007·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Ami J ShahRobertson Parkman
May 28, 2008·Best Practice & Research. Clinical Haematology·Laura Johnston
Oct 23, 2008·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Alana A Kennedy-NasserRobert A Krance
Feb 11, 2009·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Stella M DaviesNancy A Kernan

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Citations

Sep 4, 2015·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Doris M PonceJuliet N Barker
May 31, 2013·British Journal of Haematology·Claire BoothPaul Veys
Apr 12, 2013·Clinical and Experimental Immunology·C Booth, P Veys
Dec 10, 2014·Clinical Lymphoma, Myeloma & Leukemia·Jessica HochbergMitchell S Cairo
Dec 9, 2014·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Laura WillemsenMaarten J D van Tol
Jan 17, 2015·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Jan Storek
Mar 11, 2015·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Christina PetersThomas Klingebiel
May 10, 2019·Expert Review of Clinical Immunology·Reem ElfekyPaul Veys
Sep 4, 2020·Diagnostics·Anca OnaciuIoana Berindan-Neagoe
Nov 26, 2019·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Alix E SeifNancy J Bunin

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