Evidence for a GVL effect following reduced-intensity allo-SCT in ALL: a British Society of Blood and Marrow Transplantation study

P G Medd; A J Peniket; T J Littlewood; R Pearce; J Perry; K E Kirkland; Bronwen E Shaw; M N Potter; C F Craddock; D W Milligan; A K Fielding; D I Marks; G Cook

doi:10.1038/bmt.2012.261

Evidence for a GVL effect following reduced-intensity allo-SCT in ALL: a British Society of Blood and Marrow Transplantation study

P G Medd, A J Peniket, T J Littlewood, R Pearce, J Perry, K E Kirkland, Bronwen E Shaw, M N Potter, C F Craddock, D W Milligan, A K Fielding, D I Marks, G Cook

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8 Citations (Scopus)

Abstract

Myeloablative allo-SCT decreases relapse incidence (RI) in ALL. Reduced intensity conditioning (RIC) may extend allo-SCT to older and less fit patients. Sixty-nine ALL patients reported to the BSBMT underwent fludarabine-based RIC allo-SCT, 38 from unrelated donors (UD). Forty-four patients received alemtuzumab. ALL was in CR in 64 patients (93%). This was a second or third SCT in 23 patients. Two-year OS and PFS were 36% and 32%, respectively. In multivariate analysis male recipients demonstrated better OS and PFS (hazard ratio (HR)=0.42, P=0.008 and HR=0.45, P=0.012, respectively). Two-year TRM was 29%: higher with younger age (HR=0.97/year, P=0.041), female recipient (HR=2.55, P=0.049) and increasing grade of acute GVHD (HR=1.87, P=0.001). Two-year RI was 38% and was lower in patients with acute and chronic GVHD (HR=0.62 per increasing grade, P=0.035 and HR=0.52, P=0.025, respectively). Long-term ALL-free survival is achievable following fludarabine-based RIC allo-SCT. The association between GVHD and decreased RI suggests the presence of a GVL effect.

Original language	English
Pages (from-to)	982-987
Journal	Bone Marrow Transplantation
Volume	48
Issue number	7
Early online date	14 Jan 2013
DOIs	https://doi.org/10.1038/bmt.2012.261
Publication status	Published - 1 Jul 2013

Keywords

Graft-versus-tumor Effects
nonmyeloablative; graft-versus-leukaemia; fludarabine; acute lymphoblastic leukaemia; allo-SCT

Access to Document

10.1038/bmt.2012.261

8 Citations
1 Article

Evidence for a GVL effect following reduced-intensity allo-SCT in ALL: a British Society of Blood and Marrow Transplantation study (vol 48, pg 982, 2013): Bone Marrow Transplant
Medd, P. G., Peniket, A. J., Littlewood, T. J., Pearce, R., Perry, J., Kirkland, K. E., Shaw, B. E., Potter, M. N., Craddock, C. F., Milligan, D. W., Fielding, A. K., Marks, D. I. & Cook, G., 2013, In: Bone Marrow Transplantation. 48, 10, p. 1368 1 p.
Research output: Contribution to journal › Article › peer-review

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Medd, P. G., Peniket, A. J., Littlewood, T. J., Pearce, R., Perry, J., Kirkland, K. E., Shaw, B. E., Potter, M. N., Craddock, C. F., Milligan, D. W., Fielding, A. K., Marks, D. I., & Cook, G. (2013). Evidence for a GVL effect following reduced-intensity allo-SCT in ALL: a British Society of Blood and Marrow Transplantation study. Bone Marrow Transplantation, 48(7), 982-987. https://doi.org/10.1038/bmt.2012.261

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abstract = "Myeloablative allo-SCT decreases relapse incidence (RI) in ALL. Reduced intensity conditioning (RIC) may extend allo-SCT to older and less fit patients. Sixty-nine ALL patients reported to the BSBMT underwent fludarabine-based RIC allo-SCT, 38 from unrelated donors (UD). Forty-four patients received alemtuzumab. ALL was in CR in 64 patients (93%). This was a second or third SCT in 23 patients. Two-year OS and PFS were 36% and 32%, respectively. In multivariate analysis male recipients demonstrated better OS and PFS (hazard ratio (HR)=0.42, P=0.008 and HR=0.45, P=0.012, respectively). Two-year TRM was 29%: higher with younger age (HR=0.97/year, P=0.041), female recipient (HR=2.55, P=0.049) and increasing grade of acute GVHD (HR=1.87, P=0.001). Two-year RI was 38% and was lower in patients with acute and chronic GVHD (HR=0.62 per increasing grade, P=0.035 and HR=0.52, P=0.025, respectively). Long-term ALL-free survival is achievable following fludarabine-based RIC allo-SCT. The association between GVHD and decreased RI suggests the presence of a GVL effect.",

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Medd, PG, Peniket, AJ, Littlewood, TJ, Pearce, R, Perry, J, Kirkland, KE, Shaw, BE, Potter, MN, Craddock, CF, Milligan, DW, Fielding, AK, Marks, DI & Cook, G 2013, 'Evidence for a GVL effect following reduced-intensity allo-SCT in ALL: a British Society of Blood and Marrow Transplantation study', Bone Marrow Transplantation, vol. 48, no. 7, pp. 982-987. https://doi.org/10.1038/bmt.2012.261

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T1 - Evidence for a GVL effect following reduced-intensity allo-SCT in ALL: a British Society of Blood and Marrow Transplantation study

AU - Medd, P G

AU - Peniket, A J

AU - Littlewood, T J

AU - Pearce, R

AU - Perry, J

AU - Kirkland, K E

AU - Shaw, Bronwen E

AU - Potter, M N

AU - Craddock, C F

AU - Milligan, D W

AU - Fielding, A K

AU - Marks, D I

AU - Cook, G

PY - 2013/7/1

Y1 - 2013/7/1

N2 - Myeloablative allo-SCT decreases relapse incidence (RI) in ALL. Reduced intensity conditioning (RIC) may extend allo-SCT to older and less fit patients. Sixty-nine ALL patients reported to the BSBMT underwent fludarabine-based RIC allo-SCT, 38 from unrelated donors (UD). Forty-four patients received alemtuzumab. ALL was in CR in 64 patients (93%). This was a second or third SCT in 23 patients. Two-year OS and PFS were 36% and 32%, respectively. In multivariate analysis male recipients demonstrated better OS and PFS (hazard ratio (HR)=0.42, P=0.008 and HR=0.45, P=0.012, respectively). Two-year TRM was 29%: higher with younger age (HR=0.97/year, P=0.041), female recipient (HR=2.55, P=0.049) and increasing grade of acute GVHD (HR=1.87, P=0.001). Two-year RI was 38% and was lower in patients with acute and chronic GVHD (HR=0.62 per increasing grade, P=0.035 and HR=0.52, P=0.025, respectively). Long-term ALL-free survival is achievable following fludarabine-based RIC allo-SCT. The association between GVHD and decreased RI suggests the presence of a GVL effect.

AB - Myeloablative allo-SCT decreases relapse incidence (RI) in ALL. Reduced intensity conditioning (RIC) may extend allo-SCT to older and less fit patients. Sixty-nine ALL patients reported to the BSBMT underwent fludarabine-based RIC allo-SCT, 38 from unrelated donors (UD). Forty-four patients received alemtuzumab. ALL was in CR in 64 patients (93%). This was a second or third SCT in 23 patients. Two-year OS and PFS were 36% and 32%, respectively. In multivariate analysis male recipients demonstrated better OS and PFS (hazard ratio (HR)=0.42, P=0.008 and HR=0.45, P=0.012, respectively). Two-year TRM was 29%: higher with younger age (HR=0.97/year, P=0.041), female recipient (HR=2.55, P=0.049) and increasing grade of acute GVHD (HR=1.87, P=0.001). Two-year RI was 38% and was lower in patients with acute and chronic GVHD (HR=0.62 per increasing grade, P=0.035 and HR=0.52, P=0.025, respectively). Long-term ALL-free survival is achievable following fludarabine-based RIC allo-SCT. The association between GVHD and decreased RI suggests the presence of a GVL effect.

KW - Graft-versus-tumor Effects

KW - nonmyeloablative; graft-versus-leukaemia; fludarabine; acute lymphoblastic leukaemia; allo-SCT

U2 - 10.1038/bmt.2012.261

DO - 10.1038/bmt.2012.261

M3 - Article

SN - 0268-3369

VL - 48

SP - 982

EP - 987

JO - Bone Marrow Transplantation

JF - Bone Marrow Transplantation

IS - 7

ER -

Evidence for a GVL effect following reduced-intensity allo-SCT in ALL: a British Society of Blood and Marrow Transplantation study

Abstract

Keywords

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Research output

Evidence for a GVL effect following reduced-intensity allo-SCT in ALL: a British Society of Blood and Marrow Transplantation study (vol 48, pg 982, 2013): Bone Marrow Transplant

Cite this