TY - JOUR
T1 - Ex Vivo CD34+–Selected T Cell–Depleted Peripheral Blood Stem Cell Grafts for Allogeneic Hematopoietic Stem Cell Transplantation in Acute Leukemia and Myelodysplastic Syndrome Is Associated with Low Incidence of Acute and Chronic Graft-versus-Host Disease and High Treatment Response
AU - Barba, Pere
AU - Hilden, Patrick
AU - Devlin, Sean M.
AU - Maloy, Molly
AU - Dierov, Djamilia
AU - Nieves, Jimmy
AU - Garrett, Matthew D.
AU - Sogani, Julie
AU - Cho, Christina
AU - Barker, Juliet N.
AU - Kernan, Nancy A.
AU - Castro-Malaspina, Hugo
AU - Jakubowski, Ann A.
AU - Koehne, Guenther
AU - Papadopoulos, Esperanza B.
AU - Prockop, Susan
AU - Sauter, Craig
AU - Tamari, Roni
AU - van den Brink, Marcel R.M.
AU - Avecilla, Scott T.
AU - Meagher, Richard
AU - O'Reilly, Richard J.
AU - Goldberg, Jenna D.
AU - Young, James W.
AU - Giralt, Sergio
AU - Perales, Miguel Angel
AU - Ponce, Doris M.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - © 2017 The American Society for Blood and Marrow Transplantation Ex vivo CD34+–selected T cell depletion (TCD) has been developed as a strategy to reduce the incidence of graft-versus-host disease (GVHD) after allogeneic (allo) hematopoietic stem cell transplantation (HSCT). Clinical characteristics, treatment responses, and outcomes of patients developing acute (aGVHD) and chronic GVHD (cGVHD) after TCD allo-HSCT have not been well established. We evaluated 241 consecutive patients (median age, 57 years) with acute leukemia (n = 191, 79%) or myelodysplastic syndrome (MDS) (n = 50, 21%) undergoing CD34+–selected TCD allo-HSCT without post-HCST immunosuppression in a single institution. Cumulative incidences of grades II-IV and III-IV aGVHD at 180 days were 16% (95% confidence interval [CI], 12 to 21) and 5% (95% CI, 3 to 9), respectively. The skin was the most frequent organ involved, followed by the gastrointestinal tract. Patients were treated with topical corticosteroids, poorly absorbed corticosteroids (budesonide), and/or systemic corticosteroids. The overall day 28 treatment response was high at 82%. The cumulative incidence of any cGVHD at 3 years was 5% (95% CI, 3 to 9), with a median time of onset of 256 days (range, 95 to 1645). The 3-year transplant-related mortality, relapse, overall survival, and disease-free survival were 24% (95% CI, 18 to 30), 22% (95% CI, 17 to 27), 57% (95% CI, 50 to 64), and 54% (95% CI, 47 to 61), respectively. The 1-year and 3-year probabilities of cGVHD-free/relapse-free survival were 65% (95% CI, 59 to 71) and 52% (95% CI, 45 to 59), respectively. Our findings support the use of ex vivo CD34+–selected TCD allograft as a calcineurin inhibitor–free intervention for the prevention of GVHD in patients with acute leukemia and MDS.
AB - © 2017 The American Society for Blood and Marrow Transplantation Ex vivo CD34+–selected T cell depletion (TCD) has been developed as a strategy to reduce the incidence of graft-versus-host disease (GVHD) after allogeneic (allo) hematopoietic stem cell transplantation (HSCT). Clinical characteristics, treatment responses, and outcomes of patients developing acute (aGVHD) and chronic GVHD (cGVHD) after TCD allo-HSCT have not been well established. We evaluated 241 consecutive patients (median age, 57 years) with acute leukemia (n = 191, 79%) or myelodysplastic syndrome (MDS) (n = 50, 21%) undergoing CD34+–selected TCD allo-HSCT without post-HCST immunosuppression in a single institution. Cumulative incidences of grades II-IV and III-IV aGVHD at 180 days were 16% (95% confidence interval [CI], 12 to 21) and 5% (95% CI, 3 to 9), respectively. The skin was the most frequent organ involved, followed by the gastrointestinal tract. Patients were treated with topical corticosteroids, poorly absorbed corticosteroids (budesonide), and/or systemic corticosteroids. The overall day 28 treatment response was high at 82%. The cumulative incidence of any cGVHD at 3 years was 5% (95% CI, 3 to 9), with a median time of onset of 256 days (range, 95 to 1645). The 3-year transplant-related mortality, relapse, overall survival, and disease-free survival were 24% (95% CI, 18 to 30), 22% (95% CI, 17 to 27), 57% (95% CI, 50 to 64), and 54% (95% CI, 47 to 61), respectively. The 1-year and 3-year probabilities of cGVHD-free/relapse-free survival were 65% (95% CI, 59 to 71) and 52% (95% CI, 45 to 59), respectively. Our findings support the use of ex vivo CD34+–selected TCD allograft as a calcineurin inhibitor–free intervention for the prevention of GVHD in patients with acute leukemia and MDS.
KW - Acute graft-versus-host disease
KW - Chronic graft-versus-host disease
KW - T cell–depleted transplantation
U2 - 10.1016/j.bbmt.2016.12.633
DO - 10.1016/j.bbmt.2016.12.633
M3 - Article
VL - 23
SP - 452
EP - 458
IS - 3
ER -