Faculty Collaboration Database

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 2012 Jun 21;119(25):6155-61

Date

05/11/2012

Pubmed ID

22573402

Pubmed Central ID

PMC3383023

DOI

10.1182/blood-2012-01-405795

Scopus ID

2-s2.0-84862745582 (requires institutional sign-in at Scopus site)   35 Citations

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-replete transplantations were 43%, 49%, and 46%, respectively. These data suggest that in vivo T-cell depletion lowers GVHD without compromising LFS among children with acute lymphoblastic leukemia who are undergoing unrelated donor transplantation with myeloablative total body irradiation-based regimens.

Author List

Veys P, Wynn RF, Ahn KW, Samarasinghe S, He W, Bonney D, Craddock J, Cornish J, Davies SM, Dvorak CC, Duerst RE, Gross TG, Kapoor N, Kitko C, Krance RA, Leung W, Lewis VA, Steward C, Wagner JE, Carpenter PA, Eapen M

Authors

Kwang Woo Ahn PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Mary Eapen MBBS, DCh, MRCPI, MS Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Female
Granulocyte Precursor Cells
Hematopoietic Stem Cell Transplantation
Humans
Immunomodulation
Infant
Lymphocyte Count
Lymphocyte Depletion
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Registries
Retrospective Studies
T-Lymphocytes
Transplantation Conditioning
Transplantation, Homologous
Treatment Outcome
Unrelated Donors
Whole-Body Irradiation