Comparison of outcomes at two institutions of patients with ALL receiving ex vivo T-cell-depleted or unmodified allografts

• Published in: Bone marrow transplantation (Basingstoke) Vol. 50; no. 4; pp. 493 - 498
• Main Authors: Hobbs, G S, Hamdi, A, Hilden, P D, Goldberg, J D, Poon, M L, Ledesma, C, Devlin, S M, Rondon, G, Papadopoulos, E B, Jakubowski, A A, O'Reilly, R J, Champlin, R E, Giralt, S, Perales, M-A, Kebriaei, P
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.04.2015; Nature Publishing Group
• Subjects: 631/67/1990/283/2125; 692/699/67/1990/283/2125; Acute lymphocytic leukemia; Adolescent; Adult; Aged; Aged, 80 and over; Allografts; Bone marrow; Cancer; Care and treatment; Cell Biology; Cytogenetics; Depletion; Disease-Free Survival; Female; Globulins; Graft-versus-host reaction; Hematology; Hematopoietic Stem Cell Transplantation; Humans; Internal Medicine; Lymphocyte Depletion; Lymphocytes T; Male; Medicine; Medicine & Public Health; Methods; Middle Aged; Models, Biological; original-article; Patient outcomes; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Prophylaxis; Public Health; Stem cell transplantation; Stem Cells; Survival Rate; T-Lymphocytes; Thymocytes; Transplantation Conditioning
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2014.302

We compared outcomes of adult patients receiving T-cell-depleted (TCD) hematopoietic SCT (HCT) without additional GVHD prophylaxis at Memorial Sloan Kettering Cancer Center (MSKCC, N =52), with those of patients receiving conventional grafts at MD Anderson Cancer Center (MDACC, N =115) for ALL in CR1 or CR2. Patients received myeloablative conditioning. Thirty-nine patients received anti-thymocyte globulin at MSKCC and 29 at MDACC. Cumulative incidence of grades 2–4 acute ( P =0.001, 17.3% vs 42.6% at 100 days) and chronic GVHD ( P =0.006, 13.5% vs 33.4% at 3 years) were significantly lower in the TCD group. The non-relapse mortality at day 100, 1 and 3 years was 15.4, 25.0 and 35.9% in the TCD group and 9.6, 23.6 and 28.6% in the unmodified group ( P =0.368). There was no difference in relapse ( P =0.107, 21.3% vs 35.5% at 3 years), OS ( P =0.854, 42.6% vs 43.0% at 3 years) or RFS ( P =0.653, 42.8% vs 35.9% at 3 years). In an adjusted model, age >50, cytogenetics and CR status were associated with inferior RFS (hazard ratio (HR)=2.16, P =0.003, HR=1.77, P =0.022, HR=2.47, P <0.001), whereas graft type was NS (HR=0.90, P =0.635). OS and RFS rates are similar in patients undergoing TCD or conventional HCT, but TCD effectively reduces the rate of GVHD.