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T-cell-depleted autologous bone marrow transplantation therapy: analysis of
immune deficiency and late complications
KC Anderson, R Soiffer, R DeLage, T Takvorian, AS Freedman, SL Rabinowe, LM Nadler, K Dear, L Heflin and P Mauch
Division of Tumor Immunology, Dana-Farber Cancer Institute, Boston, MA
02115.
Fourteen patients with T-cell-derived leukemia and lymphoma underwent
high-dose chemoradiotherapy and anti-T-cell monoclonal antibody-treated
autologous bone marrow transplantation (ABMT). All patients were either in
sensitive relapse or had adverse prognostic features, and five patients had
a history of bone marrow involvement with disease. Patients received a
median of 2 (1 to 3) prior chemotherapy regimens; 10 patients received
local radiotherapy. After high-dose ablative therapy, greater than 500/mm3
granulocytes and greater than 20,000 untransfused platelets/mm3 were noted
at a median of 23 (13 to 48) and 26 (15 to 43) days post-ABMT,
respectively. Natural killer (NK) cells, T cells (predominantly T8+), and
monocytes were noted within the first 1 to 2 months post-AMBT, as seen in
other series. Disease-free survival was a median of 10.1 months, 5.9 months
for patients with T acute lymphoblastic leukemia or lymphoblastic lymphoma
and 25.6 months for patients with T non-Hodgkin's lymphoma (NHL).
Toxicities were common and severe. Thirty-six percent of patients developed
bacteremias early post-BMT. Late complications included a skin rash
consistent with graft versus host disease; infections with Herpes zoster,
hepatitis, and Pneumocystis carinii; and the development of Epstein-Barr
virus associated lymphoproliferative syndrome. Our findings suggest that
patients who have undergone T-depleted ABMT have a profound
immunodeficiency not reflected in the phenotypic reconstitution of the T
and NK cells. Characterization of the functional deficiency may facilitate
the development of methods to reduce the long-term toxicity of AMBT in
these patients.
Volume 76,
Issue 1,
pp. 235-244,
07/01/1990
Copyright © 1990 by The American Society of Hematology
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