|Title||Comparative outcomes of donor graft CD34+ selection and immune suppressive therapy as graft-versus-host disease prophylaxis for patients with acute myeloid leukemia in complete remission undergoing HLA-matched sibling allogeneic hematopoietic cell transpl|
|Publication Type||Journal Article|
|Year of Publication||2012|
|Authors||Pasquini, MC, Devine, S, Mendizabal, A, Baden, LR, Wingard, JR, Lazarus, HM, Appelbaum, FR, Keever-Taylor, CA, Horowitz, MM, Carter, S, O'Reilly, RJ, Soiffer, RJ|
|Journal||J Clin Oncol|
|Date Published||2012 Sep 10|
|Keywords||Antigens, CD34, Clinical Trials as Topic, Female, Graft Rejection, Graft vs Host Disease, Hematopoietic Stem Cell Transplantation, Humans, Immunosuppressive Agents, Leukemia, Myeloid, Acute, Lymphocyte Depletion, Male, Siblings, T-Lymphocyte Subsets, Treatment Outcome|
PURPOSE: T-cell depletion (TCD) reduces the incidence of graft-versus-host disease (GVHD) after hematopoietic cell transplantation (HCT). However, concerns about relapse, graft rejection, and variability in technique have limited the widespread application of this approach.
PATIENTS AND METHODS: Outcomes of 44 patients receiving HLA-identical sibling TCD grafts using a uniform technique for CD34(+) selection as the sole form of immune suppression were compared with outcomes of 84 patients receiving T-replete grafts and pharmacologic immune suppression therapy (IST).
RESULTS: Groups were similar, except for fewer men (36% with TCD v 56% with IST) and more frequent use of radiation-containing regimens (100% with TCD v 50% with IST) in the CD34-selected TCD cohort. The proportion of patients with neutrophil engraftment at day 28 was similar (96% with IST and 100% with TCD grafts). The 100-day rates of grade 2 to 4 acute GVHD were 39% and 23% with IST and TCD grafts, respectively (P = .07). Corresponding 2-year rates of chronic GVHD were lower with TCD grafts than IST (19% v 50%, respectively; P
CONCLUSION: These results suggest that TCD via CD34 selection might lower long-term morbidity as a result of chronic GVHD without negatively impacting relapse rates in patients with acute myeloid leukemia. Additional prospective studies should be undertaken to definitively address the role of TCD in HCT.
|Alternate Journal||J Clin Oncol|
|PubMed Central ID||PMC3434978|
|Grant List||U10 HL069294 / HL / NHLBI NIH HHS / United States |
UG1 HL069286 / HL / NHLBI NIH HHS / United States
U10 HL069301 / HL / NHLBI NIH HHS / United States
U10 HL069330 / HL / NHLBI NIH HHS / United States
U10 HL069249 / HL / NHLBI NIH HHS / United States
U01 HL069294 / HL / NHLBI NIH HHS / United States
U01 HL069301 / HL / NHLBI NIH HHS / United States
U10 HL069348 / HL / NHLBI NIH HHS / United States
U24 CA076518 / CA / NCI NIH HHS / United States
U10 HL069286 / HL / NHLBI NIH HHS / United States
U01HL069294 / HL / NHLBI NIH HHS / United States