TY - JOUR
T1 - Impact of in vivo T-cell depletion on outcome of AML patients in first CR given peripheral blood stem cells and reduced-intensity conditioning allo-SCT from a HLA-identical sibling donor
T2 - a report from the Acute Leukemia Working Party of the European group for Blood and Marrow Transplantation
AU - Baron, F.
AU - Labopin, M.
AU - Blaise, D.
AU - Lopez-Corral, L.
AU - Vigouroux, S.
AU - Craddock, C.
AU - Attal, M.
AU - Jindra, P.
AU - Goker, H.
AU - Socie, G.
AU - Chevallier, P.
AU - Browne, P.
AU - Sandstedt, A.
AU - Duarte, R. F.
AU - Nagler, A.
AU - Mohty, M.
PY - 2014
Y1 - 2014
N2 - The impact of in vivo T-cell depletion on transplantation outcomes in patients transplanted with reduced-intensity conditioning (RIC) remains controversial. This study assessed the outcome of 1250 adult patients with de novo AML in first CR (CR1) given PBSC from HLA-identical siblings after chemotherapy-based RIC. A total of 554 patients did not receive any form of in vivo T-cell depletion (control group), whereas antithymocyte globulin (ATG) and alemtuzumab were given in 444 and 252 patients, respectively. The incidences of grade II-IV acute GVHD were 21.4, 17.6 and 10.2% in control, ATG and alemtuzumab patients, respectively (P<0.001). In multivariate analysis, the use of ATG and the use of alemtuzumab were each associated with a lower risk of chronic GVHD (P<0.001 each), but a similar risk of relapse, and of nonrelapse mortality, and similar leukemia-free survival and OS. Further, among patients given BU-based RIC, the use of <6 mg/kg ATG did not increase the risk of relapse (hazard ratio, HR=1.1), whereas there was a suggestion for higher relapse risk in patients given greater than or equal to6 mg/kg ATG (HR=1.4, P=0.08). In summary, these data suggest that a certain amount of in vivo T-cell depletion can be safely used in the conditioning of AML patients in CR1 given PBSC after chemotherapy-based RIC.
AB - The impact of in vivo T-cell depletion on transplantation outcomes in patients transplanted with reduced-intensity conditioning (RIC) remains controversial. This study assessed the outcome of 1250 adult patients with de novo AML in first CR (CR1) given PBSC from HLA-identical siblings after chemotherapy-based RIC. A total of 554 patients did not receive any form of in vivo T-cell depletion (control group), whereas antithymocyte globulin (ATG) and alemtuzumab were given in 444 and 252 patients, respectively. The incidences of grade II-IV acute GVHD were 21.4, 17.6 and 10.2% in control, ATG and alemtuzumab patients, respectively (P<0.001). In multivariate analysis, the use of ATG and the use of alemtuzumab were each associated with a lower risk of chronic GVHD (P<0.001 each), but a similar risk of relapse, and of nonrelapse mortality, and similar leukemia-free survival and OS. Further, among patients given BU-based RIC, the use of <6 mg/kg ATG did not increase the risk of relapse (hazard ratio, HR=1.1), whereas there was a suggestion for higher relapse risk in patients given greater than or equal to6 mg/kg ATG (HR=1.4, P=0.08). In summary, these data suggest that a certain amount of in vivo T-cell depletion can be safely used in the conditioning of AML patients in CR1 given PBSC after chemotherapy-based RIC.
KW - reduced-intensity conditioning aml gvhd atg alemtuzumab acute myeloid-leukemia versus-host-disease chronic graft bone-marrow allogeneic transplantation complete remission hematologic malignancies myelodysplastic syndrome antithymocyte globulin lymphocyte
U2 - 10.1038/Bmt.2013.204
DO - 10.1038/Bmt.2013.204
M3 - Article
SN - 0268-3369
VL - 49
SP - 389
EP - 396
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
ER -