Title | Ex Vivo CD34-Selected T Cell-Depleted Peripheral Blood Stem Cell Grafts for Allogeneic Hematopoietic Stem Cell Transplantation in Acute Leukemia and Myelodysplastic Syndrome Is Associated with Low Incidence of Acute and Chronic Graft-versus-Host Disease a |
Publication Type | Journal Article |
Year of Publication | 2017 |
Authors | Barba P, Hilden P, Devlin SM, Maloy M, Dierov D, Nieves J, Garrett MD, Sogani J, Cho C, Barker JN, Kernan NA, Castro-Malaspina H, Jakubowski AA, Koehne G, Papadopoulos EB, Prockop S, Sauter C, Tamari R, van den Brink MRM, Avecilla ST, Meagher R, O'Reilly RJ, Goldberg JD, Young JW, Giralt S, Perales M-A, Ponce DM |
Journal | Biol Blood Marrow Transplant |
Volume | 23 |
Issue | 3 |
Pagination | 452-458 |
Date Published | 2017 Mar |
ISSN | 1523-6536 |
Keywords | Acute Disease, Adult, Aged, Antigens, CD34, Female, Graft vs Host Disease, Hematopoietic Stem Cell Transplantation, Humans, Incidence, Leukemia, Lymphocyte Depletion, Male, Middle Aged, Myelodysplastic Syndromes, Peripheral Blood Stem Cell Transplantation, Survival Analysis, Transplantation, Homologous, Treatment Outcome, Young Adult |
Abstract | Ex vivo CD34-selected T cell depletion (TCD) has been developed as a strategy to reduce the incidence of graft-versus-host disease (GVHD) after allogeneic (allo) hematopoietic stem cell transplantation (HSCT). Clinical characteristics, treatment responses, and outcomes of patients developing acute (aGVHD) and chronic GVHD (cGVHD) after TCD allo-HSCT have not been well established. We evaluated 241 consecutive patients (median age, 57 years) with acute leukemia (nā=ā191, 79%) or myelodysplastic syndrome (MDS) (nā=ā50, 21%) undergoing CD34-selected TCD allo-HSCT without post-HCST immunosuppression in a single institution. Cumulative incidences of grades II-IV and III-IV aGVHD at 180 days were 16% (95% confidence interval [CI], 12 to 21) and 5% (95% CI, 3 to 9), respectively. The skin was the most frequent organ involved, followed by the gastrointestinal tract. Patients were treated with topical corticosteroids, poorly absorbed corticosteroids (budesonide), and/or systemic corticosteroids. The overall day 28 treatment response was high at 82%. The cumulative incidence of any cGVHD at 3 years was 5% (95% CI, 3 to 9), with a median time of onset of 256 days (range, 95 to 1645). The 3-year transplant-related mortality, relapse, overall survival, and disease-free survival were 24% (95% CI, 18 to 30), 22% (95% CI, 17 to 27), 57% (95% CI, 50 to 64), and 54% (95% CI, 47 to 61), respectively. The 1-year and 3-year probabilities of cGVHD-free/relapse-free survival were 65% (95% CI, 59 to 71) and 52% (95% CI, 45 to 59), respectively. Our findings support the use of ex vivo CD34-selected TCD allograft as a calcineurin inhibitor-free intervention for the prevention of GVHD in patients with acute leukemia and MDS. |
DOI | 10.1016/j.bbmt.2016.12.633 |
Alternate Journal | Biol. Blood Marrow Transplant. |
PubMed ID | 28017734 |
PubMed Central ID | PMC5398850 |
Grant List | P01 CA023766 / CA / NCI NIH HHS / United States P30 CA008748 / CA / NCI NIH HHS / United States |
Submitted by kej2006 on June 6, 2018 - 4:11pm