Prevention of graft vs. host disease with alemtuzumab ‘in the bag’ decreases early toxicity of stem cell transplantation and in multiple myeloma is associated with improved long-term outcome
| Autor: | V Thomas, C. du Toit, Nicolas Novitzky |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Adult
Cancer Research medicine.medical_specialty Transplantation Conditioning CD52 Antibodies Neoplasm medicine.medical_treatment Immunology Graft vs Host Disease Antibodies Monoclonal Humanized Gastroenterology Disease-Free Survival Lymphocyte Depletion Antigens CD Antigens Neoplasm Internal medicine medicine Humans Transplantation Homologous Immunology and Allergy Alemtuzumab Genetics (clinical) Multiple myeloma Glycoproteins Transplantation Chemotherapy Performance status business.industry Graft Survival Antibodies Monoclonal Cell Biology Middle Aged medicine.disease Surgery Radiation therapy Treatment Outcome CD52 Antigen Oncology Stem cell Multiple Myeloma business Stem Cell Transplantation medicine.drug |
| Zdroj: | Cytotherapy. 10:45-53 |
| ISSN: | 1465-3249 |
| Popis: | Allogeneic stem cell transplantation in multiple myeloma (MM) is controversial because treatment-related mortality and relapse remain a substantial challenge.Patients with symptomatic MM responsive to therapy received myeloablative conditioning with radiotherapy (n=12) or chemotherapy (n=10) followed by infusion of HLA-identical grafts from a sibling. Graft vs. host disease (GvHD) prophylaxis consisted of 'ex vivo' T-cell depletion with CAMPATH-1 antibody. The objective of the study was to determine transplant-related mortality (TRM), GvHD, overall survival (OS) and Disease free Survival (DFS).Twenty-two patients, median age 45 (range 37-56) years, had a median performance status of 1 (0-2). Patients received a median of 23.8 x 10(4)/kg CFU-GM and 4.31 x 10(6)/kg CD34. Median time to engraftment was 13 days. The day-100 and 1-year TRM was 9% and 20%, respectively. Ten patients suffered disease recurrence. Four of eight patients remained in remission after infusions of donor lymphocyte (DLI) containing a median total of 0.67 x 10(8)/kg CD3 cells. Three-year OS was 56%, and 50% remained disease free at a median of 1101 days (range 385-5309). Multiple regression analysis showed that bone marrow (vs. peripheral blood stem cell) (P=0.03), presentation of low albumin (P=0.02) and a higher dose of CAMPATH-1H (P=0.01) were adverse factors for survival. Cox analysis confirmed that a lower CAMPATH-1H dose was associated with improved outcome.In chemotherapy-responsive patients with myeloma, T-cell depletion of allogeneic grafts was associated with an acceptable 1-year TRM and seemed to have a favorable impact on long-term survival. |
| Databáze: | OpenAIRE |
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