In Vivo T Cell Depletion with Myeloablative Regimens on Outcomes after Cord Blood Transplantation for Acute Lymphoblastic Leukemia in Children. Biol Blood Marrow Transplant 2015 Dec;21(12):2173-2179
Date
09/04/2015Pubmed ID
26327630Pubmed Central ID
PMC4639413DOI
10.1016/j.bbmt.2015.08.022Scopus ID
2-s2.0-84947422775 (requires institutional sign-in at Scopus site) 18 CitationsAbstract
The inclusion of antithymocyte globulin (ATG) in cord blood transplantation is controversial. We evaluated outcomes according to ATG inclusion in 297 children and adolescents with acute lymphoblastic leukemia (ALL) who received myeloablative total body irradiation-based conditioning and either single-unit (74%) or double-unit (26%) grafts. Ninety-two patients (31%) received ATG and 205 (69%) did not. ATG recipients were more likely to be cytomegalovirus seronegative. The incidences of day 100 grades II to IV acute graft-versus-host disease (GVHD; 30% versus 54%, P = .0002) and chronic GVHD (22% versus 43%, P = .0008) were lower with ATG compared with non-ATG regimens. However, day 100 grades III to IV acute GVHD was comparable (11% versus 17%, P = .15). The 3-year incidences of transplant-related mortality (16% versus 17%, P = .98), relapse (17% versus 27%, P = .12), and leukemia-free survival (66% versus 55%, P = .23) in ATG and non-ATG recipients were similar. There were no differences in viral reactivation between treatment groups (60% versus 58%, P = .83). Therefore, the data suggest that incorporation of ATG with myeloablative conditioning regimens may be useful in reducing the risk of acute and chronic GVHD without any deleterious effect on transplant-related mortality, relapse, or leukemia-free survival in children and adolescents with ALL.
Author List
Ponce DM, Eapen M, Sparapani R, O'Brien TA, Chan KW, Chen J, Craddock J, Schultz KR, Wagner JE, Perales MA, Barker JNAuthors
Mary Eapen MBBS, DCh, MRCPI, MS Professor in the Medicine department at Medical College of WisconsinRodney Sparapani PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Acute DiseaseAdolescent
Antilymphocyte Serum
Child
Child, Preschool
Cord Blood Stem Cell Transplantation
Female
Graft Survival
Graft vs Host Disease
Humans
Immunosuppressive Agents
Infant
Lymphocyte Depletion
Male
Myeloablative Agonists
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Recurrence
Remission Induction
Retrospective Studies
Survival Analysis
Transplantation Conditioning
Transplantation, Homologous
Treatment Outcome
Whole-Body Irradiation
Young Adult
