Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2007 Dec 15;110(13):4552-9.
doi: 10.1182/blood-2007-06-093880. Epub 2007 Aug 23.

T cell depleted stem-cell transplantation for adults with hematologic malignancies: sustained engraftment of HLA-matched related donor grafts without the use of antithymocyte globulin

Ann A Jakubowski  1 , Trudy N Small, James W Young, Nancy A Kernan, Hugo Castro-Malaspina, Katherine C Hsu, Miguel-Angel Perales, Nancy Collins, Christine Cisek, Michelle Chiu, Marcel R M van den Brink, Richard J O'Reilly, Esperanza B Papadopoulos
Affiliations
Clinical Trial

T cell depleted stem-cell transplantation for adults with hematologic malignancies: sustained engraftment of HLA-matched related donor grafts without the use of antithymocyte globulin

Ann A Jakubowski et al. Blood. .

Abstract

Antithymocyte globulin (ATG) has been used in allogeneic stem-cell transplantation to prevent graft rejection and graft-versus-host disease (GvHD). Its use, however, has been associated with delayed T-cell reconstitution and prolonged susceptibility to opportunistic infections (OIs) especially in patients undergoing T cell-depleted (TCD) transplantation. Recently, a prospective trial was conducted in 52 adult patients (median age, 47 years) with various hematologic malignancies undergoing TCD transplantation from HLA-matched related donors without the use of ATG. The cytoreductive regimen consisted of hyperfractionated total body irradiation (HFTBI), thiotepa, and fludarabine. The preferred source of the graft was peripheral blood stem cells (PBSCs). No additional graft rejection or GvHD prophylaxis was given. All evaluable patients engrafted without any immune-mediated graft rejections. Disease-free survival (DFS) at 3 years was 61% in all patients, and 70% in patients with standard-risk disease. Acute GvHD was limited to grade 2 in 8% and chronic GvHD in 9% of patients. Life-threatening OIs occurred in 3 of 52 patients and was fatal in 1. This study demonstrates durable engraftment with a low incidence of GvHD despite the lack of ATG, as well as the curative potential of this regimen.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Kaplan-Meier estimates of the probability of DFS based on status of disease.
Figure 2
Figure 2
Kaplan-Meier estimates of the probability of DFS at 2 years after transplantation for patients younger than 50 years and 50 years or older with standard-risk disease.
Figure 3
Figure 3
Cause-specific analysis of relapse and mortality. (A) Cause-specific probability of relapse, controlling for the competing risks of treatment failure by nonrelapse causes. (B) Cause-specific probability of death, adjusting for the competing risk of relapse.
Figure 4
Figure 4
T-cell recovery. Shown are the 10th, 50th, and 90th percentiles (solid lines, ●) of CD4+ and CD4+ CD45RA+ cells per microliter obtained over 24 to 36 months after transplantation in patients on the current study.
See this image and copyright information in PMC

References

    1. Young JW, Papadopoulos EB, Cunningham I, et al. T-cell depleted allogeneic bone marrow transplantation in adults with acute nonlymphocytic leukemia in first remission. Blood. 1992;79:3380–3387. - PubMed
    1. Papadopoulos EB, Carabasi MH, Castro-Malaspina H, et al. T-cell depleted allogeneic bone marrow transplantation as postremission therapy for acute myelogenous leukemia: freedom from relapse in the absence of graft-versus-host-disease. Blood. 1998;91:1083–1090. - PubMed
    1. Small TN, Avigan D, Dupont B, et al. Immune reconstitution following T-cell depleted bone marrow transplantation: effect of age and posttransplant graft rejection prophylaxis. Biol Blood Marrow Transplant. 1997;3:65–75. - PubMed
    1. Byrd JC, Mrozek K, Dodge RK, et al. Pretreatment cytogenetic abnormalities are predictive of induction success, cumulative incidence of relapse, and overall survival in adult patients with de novo acute myeloid leukemia: results from Cancer and Leukemia Group B (CALGB 8461). Blood. 2002;100:4325–4336. - PubMed
    1. Shank B, Chu FCH, Dinsmore R, et al. Hyperfractionated total body irradiation for bone marrow transplantation: results in seventy leukemia patients with allogeneic transplant. Int J Radiat Oncol Biol Phys. 1983;9:1607–1611. - PubMed

Publication types