Autologous graft-versus-host disease–like syndrome after an alemtuzumab-containing conditioning regimen and autologous stem cell transplantation for chronic lymphocytic leukemia

• Published in: Blood Vol. 108; no. 6; pp. 2127 - 2130
• Main Authors: Zenz, Thorsten, Ritgen, Matthias, Dreger, Peter, Kröber, Alexander, Barth, Thomas F., Schlenk, Richard, Böttcher, Sebastian, Hallek, Michael J., Kneba, Michael, Bunjes, Donald, Döhner, Hartmut, Stilgenbauer, Stephan
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 15.09.2006; The Americain Society of Hematology
• Subjects: Adult; Aged; Alemtuzumab; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Antibodies, Neoplasm - therapeutic use; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Female; Graft vs Host Disease - etiology; Hematologic and hematopoietic diseases; Humans; Leukemia, Lymphocytic, Chronic, B-Cell - therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Stem Cell Transplantation - adverse effects; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation Conditioning; Transplantation, Autologous; Autoimmunity; Immunopathology; Stem cell; Hematopoietic cell; Graft versus host reaction; Malignant hemopathy; Alemtuzumab; Monoclonal antibody; Autograft; Chronic; Chronic lymphocytic leukemia; Treatment; Lymphoproliferative syndrome; Graft; Conditioning
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2006-04-007898

A high incidence of autologous graft-versus-host-disease (auto-GVHD) was observed after an alemtuzumab-containing conditioning regimen and autologous stem cell transplantation (auto-SCT) for chronic lymphocytic leukemia (CLL). Skin rash developed in almost all surviving patients (87%). In 7 patients (58%), a diagnosis of auto-GVHD was made (compared with 0% after TBI/Cy; P = .01). All patients with auto-GVHD required immunosuppression, and 3 of 7 were hospitalized because of GVHD. The median duration of GVHD was 517 days (range, 60-867 days). Auto-GVHD was associated with an abnormally high CD4/CD8 ratio because of severe depletion of CD8+ T cells, pointing to a potential pathomechanism. High non–relapse-related mortality led to the discontinuation of the trial. Current results do not support the use of high-dose alemtuzumab combined with total body irradiation (TBI) and autologous stem cell transplantation (auto-SCT). However, the addition of alemtuzumab led to improved disease control at the molecular level. Longer follow-up will show whether the GVHD-like syndrome may contribute to prolonged minimal residual disease (MRD) negativity.