| Autor: |
J. Z. Wimperis, George Janossy, J. K. Pattinson, A. Thomas, J.-P. Grob, N. Bell, John F. Hancock, H. G. Prentice, A. V. Hoffbrand, M. J. M. L. Gilmore, D. Skeggs, Malcolm K. Brenner, J. Patterson |
| Rok vydání: |
1986 |
| Předmět: |
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| Zdroj: |
Minimal Residual Disease in Acute Leukemia 1986 ISBN: 9789401083980 |
| DOI: |
10.1007/978-94-009-4273-8_30 |
| Popis: |
Since May 1983 and following the institution of our present studies of “total” T-lymphocyte depletion for graft versus host disease (GvHD) prevention we have transplanted 22 patients in first complete remission (1st CR) of acute leukaemia using HLA identical sibling donors. The murine monoclonal antibodies (McAbs) RFT8 + MBG6 (or RFT12 in 4) were used in combination with rabbit complement (C′) to achieve a mean 97.7% T-lymphocyte lysis in vitro. We have used a fast dose rate (mean 15.45cGy/min received mid-plane) total body irradiation (mean average mid-plane dose 730cGy) combined with cyclophosphamide 120mg/kg. Five patients had high dose Ara-C 4 of whom received only 90mg cyclophosphamide: the fifth received 120mg/kg. In the absence of GvHD no post-BMT immunosuppressive drugs were given. Engraftment assessed by a granulocyte count of 0.5 × 109/l took a mean 23 days (range 14–72). Seventeen patients survived in CR from 18 to 881 days. Five patients have died, 2 from heart failure (CCF), 1 from cytomegalovirus pneumonitis (CMV I.pn), 1 from idiopathic pneumonitis (ID I.pn) and 1 following delayed graft failure. Five patients have had acute graft versus host disease (aGvHD), grade 1 in four and grade 2 in one. Three had mild chronic graft versus host disease (cGVHD). One patient has cholestatic jaundice of unknown cause. Preliminary analysis of immune reconstitution shows only modest T subset imbalance and preservation of NK cell function. Additionally we have demonstrated effective and useful adoptive transfer of B-cell immunity from donor to recipient. No patient has so far suffered a leukaemic relapse. The actuarial predicted survival at 21/2 years is 74% in this patient group. In conclusion T-depleted allogeneic BMT using single fraction TBI is practical, reduces considerably the risks of GvHD and the need for post-transplant immunosuppressive drugs, is not associated with any increased risk of leukaemic relapse (in this series) and appears to allow regulated regeneration of donor derived immune function. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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