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CD6-depleted allogeneic bone marrow transplantation for acute leukemia in
first complete remission
RJ Soiffer, D Fairclough, M Robertson, E Alyea, K Anderson, A Freedman, L Bartlett-Pandite, D Fisher, RL Schlossman, R Stone, C Murray, A Freeman, K Marcus, P Mauch, L Nadler and J Ritz
Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard
Medical School, Boston, MA 02115, USA.
The appropriate timing of bone marrow transplantation (BMT) for adults with
acute myelogenous leukemia (AML) and acute lymphoblastic leukemia (ALL) is
controversial. Although allogeneic transplantation results in a lower risk
of disease recurrence than intensive chemotherapy alone, overall outcome
following BMT may not be improved due to the higher incidence of
therapy-related fatal complications, frequently as a result of the
development of graft-versus-host disease (GVHD). Selective T-cell depletion
of donor marrow can reduce the incidence of GVHD and thereby limit
transplant-related toxicity. Herein we report the risk of GVHD, incidence
of transplant related mortality (TRM), likelihood of disease relapse, and
overall survival in adult patients undergoing BMT with CD6 depleted
allogeneic marrow for acute leukemia in first remission. Forty-one
consecutive allogeneic transplants were performed on patients with acute
leukemia and high-risk features (28 AML, 13 ALL) using T12 monoclonal
antibody and complement to remove CD6+ T cells from donor marrow. No pre-
or posttransplant immune suppressive medications for GVHD prophylaxis were
administered. The actuarial estimated risk of grade 2 to 4 acute GVHD was
15% in patients receiving HLA identical grafts. Chronic GVHD developed in
five patients. The estimated risk of TRM for patients in first complete
remission was 5% at Day +100 and 16% at 2 years. Fatalities attributable to
infection with cytomegalovirus or Epstein-Barr virus occurred in only three
patients. Estimated probabilities of relapse, overall survival, and
event-free survival at 4 years were 25%, 71%, and 63%, respectively. No
significant differences in GVHD, TRM, relapse rate, or survival was
observed for patients with AML compared with those with ALL. Allogeneic
transplantation with CD6 depleted bone marrow is effective in consolidating
remissions of high-risk patients with acute leukemia in first remission
without excessive toxicity.
Volume 89,
Issue 8,
pp. 3039-3047,
04/15/1997
Copyright © 1997 by The American Society of Hematology
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