|
|
 Previous Article | Table of Contents | Next Article 
Identification of Patients Who May Benefit From Prophylactic
Immunotherapy After Bone Marrow Transplantation for Acute Myeloid
Leukemia on the Basis of Lymphocyte Recovery Early After
Transplantation
Ray Powles,
Seema Singhal,
Jennifer Treleaven,
Samar Kulkarni,
Clive Horton, and
Jayesh Mehta
From the Leukaemia Unit, Royal Marsden Hospital, Surrey, UK.
Two hundred and one patients (median age, 29 years) with acute
myeloid leukemia (AML) underwent bone marrow transplantation (BMT) from
HLA-identical sibling donors after conditioning with melphalan-total-body irradiation (TBI) (57%), cyclophosphamide-TBI (35%), or chemotherapy alone (8%). Graft-versus-host disease (GVHD) prophylaxis included cyclosporine alone (68%),
cyclosporine-methotrexate (26%), or T-cell depletion (6%). The
probability of relapse was calculated as a function of the absolute
lymphocyte count (109/L) on days 27 to 30 posttransplant
(<0.1 v  0.1, <0.2 v 0.2, and <0.3 v
0.3). In each of these 12 comparisons, the probability of relapse
was higher for the group with the lower lymphocyte count. Because the
difference was most significant (P = .004) for an absolute
lymphocyte count of <0.2 on day 29 (3-year relapse probability, 42%)
versus 0.2 (16%), this variable was included in a Cox model to
determine factors independently affecting relapse. Multivariate
analysis showed that conditioning regimens other than melphalan-TBI, a
low lymphocyte count on day 29, French-American-British (FAB) subtypes
M4-7, and a nucleated cell dose of > 2.42 × 108/kg was
associated with a higher risk of relapse. We conclude that slow
lymphocyte recovery after allogeneic BMT, to < 0.2 × 109/L 29 days in this analysis, appears to be associated
with a higher risk of relapse in patients with AML. This group of
patients may benefit from posttransplant immune manipulations such as
abbreviated GVHD prophylaxis, or donor cell or cytokine administration
to enhance graft-versus-leukemia reactions to reduce relapse.
Blood, Vol. 91 No. 9 (May 1), 1998:
pp. 3481-3486
© 1998 by The American Society of Hematology.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
J. K. Davies, J. G. Gribben, L. L. Brennan, D. Yuk, L. M. Nadler, and E. C. Guinan
Outcome of alloanergized haploidentical bone marrow transplantation after ex vivo costimulatory blockade: results of 2 phase 1 studies
Blood,
September 15, 2008;
112(6):
2232 - 2241.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. G. Meyer, C. M. Britten, D. Wehler, K. Bender, G. Hess, A. Konur, U. F. Hartwig, T. C. Wehler, A. J. Ullmann, C. Gentilini, et al.
Prophylactic transfer of CD8-depleted donor lymphocytes after T-cell-depleted reduced-intensity transplantation
Blood,
January 1, 2007;
109(1):
374 - 382.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. N. Savani, K. Rezvani, S. Mielke, A. Montero, R. Kurlander, C. S. Carter, S. Leitman, E. J. Read, R. Childs, and A. J. Barrett
Factors associated with early molecular remission after T cell-depleted allogeneic stem cell transplantation for chronic myelogenous leukemia
Blood,
February 15, 2006;
107(4):
1688 - 1695.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Tauro, C. Craddock, K. Peggs, G. Begum, P. Mahendra, G. Cook, J. Marsh, D. Milligan, A. Goldstone, A. Hunter, et al.
Allogeneic Stem-Cell Transplantation Using a Reduced-Intensity Conditioning Regimen Has the Capacity to Produce Durable Remissions and Long-Term Disease-Free Survival in Patients With High-Risk Acute Myeloid Leukemia and Myelodysplasia
J. Clin. Oncol.,
December 20, 2005;
23(36):
9387 - 9393.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Nieto, E. J. Shpall, I. K. McNiece, S. Nawaz, J. Beaudet, S. Rosinski, J. Pellom, V. Slat-Vasquez, P. A. McSweeney, S. I. Bearman, et al.
Prognostic Analysis of Early Lymphocyte Recovery in Patients with Advanced Breast Cancer Receiving High-Dose Chemotherapy with an Autologous Hematopoietic Progenitor Cell Transplant
Clin. Cancer Res.,
August 1, 2004;
10(15):
5076 - 5086.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. G. Laport, B. L. Levine, E. A. Stadtmauer, S. J. Schuster, S. M. Luger, S. Grupp, N. Bunin, F. J. Strobl, J. Cotte, Z. Zheng, et al.
Adoptive transfer of costimulated T cells induces lymphocytosis in patients with relapsed/refractory non-Hodgkin lymphoma following CD34+-selected hematopoietic cell transplantation
Blood,
September 15, 2003;
102(6):
2004 - 2013.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. F. Porrata, M. A. Gertz, D. J. Inwards, M. R. Litzow, M. Q. Lacy, A. Tefferi, D. A. Gastineau, A. Dispenzieri, S. M. Ansell, I. N. M. Micallef, et al.
Early lymphocyte recovery predicts superior survival after autologous hematopoietic stem cell transplantation in multiple myeloma or non-Hodgkin lymphoma
Blood,
August 1, 2001;
98(3):
579 - 585.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Singhal, R. Powles, J. Mehta, T. R. Klumpp, H. Goker, W. I. Bensinger, B. Storer, and F. R. Appelbaum
Hematopoietic Reconstitution by Transplantation of Stem Cells from Bone Marrow or Blood
N. Engl. J. Med.,
May 24, 2001;
344(21):
1641 - 1642.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Kulkarni, R. Powles, J. Treleaven, U. Riley, S. Singhal, C. Horton, B. Sirohi, N. Bhagwati, S. Meller, R. Saso, et al.
Chronic graft versus host disease is associated with long-term risk for pneumococcal infections in recipients of bone marrow transplants
Blood,
June 15, 2000;
95(12):
3683 - 3686.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
