Ex Vivo T Cell-Depleted Hematopoietic Stem Cell Transplantation for Adult Patients with Acute Myelogenous Leukemia in First and Second Remission: Long-Term Disease-Free Survival with a Significantly Reduced Risk of Graft-versus-Host Disease
| Autor: | Miguel-Angel Perales, Ann A. Jakubowski, Izaskun Ceberio, Brian C. Shaffer, Doris M. Ponce, Molly Maloy, Patrick Hilden, Juliet N. Barker, Roni Tamari, Sergio Giralt, Juan Montoro, Craig S. Sauter, Esperanza B. Papadopoulos, Parastoo B. Dahi, James W. Young, Guenther Koehne, Richard J. O'Reilly, Hugo Castro-Malaspina |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
medicine.medical_specialty Transplantation Conditioning medicine.medical_treatment T-Lymphocytes Graft vs Host Disease Hematopoietic stem cell transplantation Gastroenterology Disease-Free Survival Article Myelogenous Internal medicine medicine Humans Transplantation Homologous Cumulative incidence Retrospective Studies Transplantation business.industry Hematopoietic Stem Cell Transplantation Hematology Middle Aged medicine.disease Confidence interval Leukemia Leukemia Myeloid Acute Graft-versus-host disease business Ex vivo |
| Zdroj: | Biol Blood Marrow Transplant |
| ISSN: | 1523-6536 |
| Popis: | Large series of patients with acute myelogenous leukemia (AML) after ex vivo T cell-depleted (TCD) allogeneic hematopoietic stem cell transplantation (allo-HSCT) have not been reported previously. We retrospectively analyzed the outcomes of 266 patients (median age, 54 years) with AML who received CD34-selected TCD allo-HSCTs while in first (75%) or second (25%) complete remission (CR1/CR2) at a single institution. The conditioning regimens were all myeloablative, and no additional graft-versus-host disease (GVHD) prophylaxis was given. The cumulative incidences of grade II-IV and grade III-IV acute GVHD at 180 days were 14% (95% confidence interval [CI], 10% to 18%) and 3% (95% CI, 1% to 5%), respectively. The cumulative incidence of chronic GVHD at 3 years was 3% (95% CI, 1% to 6%). The 3-year cumulative incidence of nonrelapse mortality was 21% (95% CI, 16% to 26%) and that of relapse was 21% (95% CI, 17% to 27%). Overall survival (OS) and disease-free survival (DFS) at 1, 3, and 5 years were 75%, 61%, and 56% and 68%, 57%, and 53%, respectively. There were no significant differences in OS, DFS, and relapse rates for patients who underwent transplantation in CR1 and those who did so in CR2. However, patients with high-risk cytogenetics at diagnosis had significantly poorer outcomes. The OS and DFS rates compare favorably with those for unmodified allo-HSCT, but with considerably lower rates of GVHD. |
| Databáze: | OpenAIRE |
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