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Blood, Vol. 95 No. 12 (June 15), 2000:
pp. 3996-4003
T-cell depletion of bone marrow transplants for
leukemia from donors other than HLA-identical siblings: advantage of
T-cell antibodies with narrow specificities
Richard E. Champlin,
Jakob R. Passweg,
Mei-Jie Zhang,
Philip A. Rowlings,
Corey J. Pelz,
Kerry A. Atkinson,
A. John Barrett,
Jean-Yves Cahn,
William R. Drobyski,
Robert Peter Gale,
John M. Goldman,
Alois Gratwohl,
Edward C. Gordon-Smith,
P. Jean Henslee-Downey,
Roger H. Herzig,
John P. Klein,
Alberto M. Marmont,
Richard J. O'Reilly,
Olle Ringdén,
Shimon Slavin,
Kathleen A. Sobocinski,
Bruno Speck,
Roy S. Weiner, and
Mary M. Horowitz
From the International Bone Marrow Transplant Registry; Health
Policy Institute (M.J.Z., P.A.R., C.J.P., J.P.K., K.A.S., M.M.H.) and
the Division of Hematology/Oncology (W.R.D.), Medical College of
Wisconsin, Milwaukee, WI; MD Anderson Cancer Center, Houston, TX
(R.E.C.); Kantonsspital Basel, Basel, Switzerland (J.R.P., A.G., B.S.);
Coulter Cellular Therapies, Medford, MA (K.A.A.); National Heart, Lung,
and Blood Institute, Bethesda, MD (A.J.B.); Hôpital Jean Minjoz,
Besancon, France (J.-Y.C.); Center for Advanced Studies in Leukemia,
Santa Monica, CA (R.P.G.); Royal Postgraduate Medical School (J.M.G.)
and St. Georges Hospital Medical School (E.C.G.-S.), London, UK;
University of South Carolina, Columbia, SC (P.J.H.-D.); University of
Louisville, Louisville, KY (R.H.H.); Ospedale San Martino, Genoa, Italy
(A.M.M.); Memorial Sloan-Kettering Cancer Center, New York, NY
(R.J.O.); Huddinge University Hospital, Huddinge, Sweden (O.R.);
Hadassah University Hospital, Jerusalem, Israel (S.S.); Tulane
University Medical Center, New Orleans, LA (R.S.W.).
T-cell depletion of donor marrow decreases graft-versus-host
disease resulting from transplants from unrelated and human leukocyte antigen (HLA)-mismatched related donors. However, there are diverse strategies for T-cell-depleted transplantation, and it is uncertain whether any improve leukemia-free survival (LFS). To compare strategies for T-cell-depleted alternative donor transplants and to compare T-cell depleted with non-T-cell-depleted transplants, we studied 870 patients with leukemia who received T-cell-depleted transplants from
unrelated or HLA-mismatched related donors from 1982 to 1994. Outcomes
were compared with those of 998 non-T-cell-depleted transplants. We
compared LFS using different strategies for T-cell-depleted transplantation considering T-cell depletion technique, intensity of
pretransplant conditioning, and posttransplant immune
suppression using proportional hazards regression to adjust for other
prognostic variables. Five categories of T-cell depletion techniques
were considered: narrow-specificity antibodies, broad-specificity
antibodies, Campath antibodies, elutriation, and lectins. Strategies
resulting in similar LFS were pooled to compare T-cell-depleted with
non-T-cell-depleted transplants. Recipients of transplants T-cell
depleted by narrow-specificity antibodies had lower treatment failure
risk (higher LFS) than recipients of transplants T-cell depleted by
other techniques. Compared with non-T-cell-depleted transplants
(5-year probability ± 95% confidence interval [CI] of LFS, 31% ± 4%), 5-year LFS was 29% ± 5% (P = NS) after
transplants T-cell depleted by narrow-specificity antibodies and
16% ± 4% (P < .0001) after transplants T-cell
depleted by other techniques. After alternative donor transplantation, T-cell depletion of donor marrow by narrow-specificity antibodies resulted in LFS rates that were higher than those for transplants T-cell depleted using other techniques but similar to those for non-T-cell-depleted transplants.
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