Faculty Collaboration Database

Unrelated donor peripheral blood stem cell transplants incorporating pre-transplant in-vivo alemtuzumab are not associated with any increased risk of significant acute or chronic graft-versus-host disease. Br J Haematol 2011 Apr;153(2):244-52

Date

03/09/2011

Pubmed ID

21382020

DOI

10.1111/j.1365-2141.2011.08615.x

Scopus ID

2-s2.0-79953080775 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

There is little information published comparing peripheral blood stem cells (PBSC) with bone marrow (BM) as the stem cell source in the long-term outcome in recipients of T-cell depleted (TCD) unrelated donor (UD) transplants. We present retrospective outcome data on 306 recipients of myeloablative, human leucocyte antigen-matched UD allografts using pre-transplant in-vivo Alemtuzumab. Transplants were performed between 2000 and 2007 for chronic myeloid leukaemia in first chronic phase and acute leukaemia in first or second complete remission; 184 patients received BM and 122 PBSC. The median age was 28·9 years (<1-58) and the median follow-up was 48 months. Overall survival at 8 years was 53%. The incidence of acute graft-versus-host disease (GvHD) was significantly higher in PBSC (65%) than BM recipients (49%; P=0·012). This represented only grade 1 GvHD with no difference in grade II-IV aGvHD (BM 23% PBSC 24%). The incidence of chronic GvHD, either overall (BM 47%, PBSC 49%) or extensive (BM 15%, PBSC 13%) was not increased with PBSC. The incidence of relapse, non-relapse mortality and survival were not significantly different. Whilst accepting the limitations of retrospective analyses, we suggest the increased risk of GvHD in recipients of PBSC in T-replete transplants is offset by in-vivo Alemtuzumab, and that either stem cell source can be used with good outcomes in this setting.

Author List

Shaw BE, Apperley JF, Russell NH, Craddock C, Liakopoulou E, Potter MN, Wynn R, Gibson B, Pearce RM, Kirkland K, Lee J, Madrigal JA, Cook G, Byrne JL

Author

Bronwen E. Shaw MBChB, PhD Center Director, Professor in the Medicine department at Medical College of Wisconsin

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

Acute Disease
Adolescent
Adult
Alemtuzumab
Antibodies, Monoclonal, Humanized
Antineoplastic Agents
Child
Child, Preschool
Chronic Disease
Disease-Free Survival
Female
Graft vs Host Disease
Humans
Infant
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Male
Middle Aged
Peripheral Blood Stem Cell Transplantation
Retrospective Studies
Risk Factors
Survival Rate
Transplantation, Homologous
Unrelated Donors