Sufficient Immunosuppression with Thymoglobulin Is Essential for a Successful Haplo-Myeloid Bridge in Haploidentical-Cord Blood Transplantation

Autor: Rick Admiraal, Caroline A. Lindemans, Marc Bierings, Liane te Boome, Els C. Jol-van der Zijde, A. Birgitta Versluijs, Jürgen Kuball, A.M.J. Wensing, Jaap Jan Boelens
Jazyk: angličtina
Rok vydání: 2015
Předmět:
Graft Rejection
Male
Oncology
FUSION PROTEIN
Time Factors
Myeloid
SEVERE APLASTIC-ANEMIA
Neutrophils
T-Lymphocytes
medicine.medical_treatment
Graft vs Host Disease
Kaplan-Meier Estimate
Fanconi anemia
MEMORY T-CELLS
TOTAL-BODY IRRADIATION
Child
Non-U.S. Gov't
Alemtuzumab
Haplo-cord transplantation
Hematology
Thymoglobulin
Research Support
Non-U.S. Gov't
Graft Survival
Immunosuppression
ALLOGRAFT SURVIVAL
Middle Aged
Total body irradiation
Treatment Outcome
surgical procedures
operative
medicine.anatomical_structure
Area Under Curve
Child
Preschool
Histocompatibility
ANTI-CD2 MONOCLONAL-ANTIBODY
Female
Cord Blood Stem Cell Transplantation
Rabbits
Unrelated Donors
Infection
Immunosuppressive Agents
Adult
medicine.medical_specialty
endocrine system
Adolescent
Endpoint Determination
Dose-Response Relationship
Immunologic
Neutropenia
Antibodies
Monoclonal
Humanized
Research Support
Lymphocyte Depletion
Internal medicine
medicine
Journal Article
Animals
Humans
SAFETY PROFILE
Antilymphocyte Serum
Transplantation
business.industry
Infant
Newborn
Infant
Engraftment
STEM-CELL TRANSPLANTATION
medicine.disease
BONE-MARROW-TRANSPLANTATION
ATG
Haplotypes
Immunology
FANCONI-ANEMIA
business
Zdroj: Biology of Blood and Marrow Transplantation, 21(10), 1839. Elsevier Inc.
Biology of Blood and Marrow Transplantation, 21(10), 1839-1852
ISSN: 1083-8791
Popis: In haploidentical (haplo)-cord blood (CB) transplantations, early haplo donor engraftment serves as a myeloid bridge to sustainable CB engraftment and is associated with early neutrophil recovery. The conditioning regimens as published for haplo-cord protocols usually contain serotherapy, such as rabbit antithymocyte globulin (ATG) (Thymoglobulin, Genzyme, Cambridge, MA). However, reducing or omitting serotherapy is an important strategy to improve early immune reconstitution after transplantation. The need for serotherapy in successful haplo-cord transplantation, defined as having a haplo-derived myeloid bridge to CB engraftment, has not been investigated before. Two consecutive cohorts of patients underwent transplantation with haplo-CB. The first group underwent transplantation with haplo-CB for active infection and/or an underlying condition with expected difficult engraftment without a conventional donor available. They received a single unit (s) CB and haplo donor cells (CD34(+) selected, 5 x 10(6) CD34(+)/kg). The second cohort included patients with poor-risk malignancies, not eligible for other treatment protocols. They received a sCB and haplo donor cells (CD19/alpha beta TCR-depleted; 5 x 10(6) CD34(+)/kg). Retrospectively in both cohorts, active ATG (Thymoglobulin) levels were measured and post hematopoietic cell transplantation area under the curve (AUC) was calculated. The influence of ATG exposure for having a successful haplo-myeloid bridge (early haplo donor engraftment before CB engraftment and no secondary neutropenia) and transplantation-related mortality (TRM) were analyzed as primary endpoints. Twenty patients were included (16 in the first cohort and 4 in the second cohort). In 58% of evaluable patients, there was no successful haplo-derived myeloid bridge to CB engraftment, for which a low post-transplantation ATG exposure appeared to be a predictor (P
Databáze: OpenAIRE
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