Submitted April 4, 2006
Accepted May 9, 2006
Autologous graft versus host disease-like syndrome
after an alemtuzumab containing conditioning regimen and
autologous stem cell transplantation for chronic lymphocytic leukemia
Thorsten Zenz, Matthias Ritgen, Peter Dreger, Alexander Krober, Thomas F Barth, Richard Schlenk, Sebastian Bottcher, Michael J Hallek, Michael Kneba, Donald Bunjes, Hartmut Dohner, and Stephan Stilgenbauer*
Department of Internal Medicine III, University of Ulm
Department of Internal Medicine II, University of Kiel
Department of Internal Medicine V, University of Heidelberg
Department of Pathology, University of Ulm
Department of Internal Medicine I, University of Cologne
* Corresponding author; email: stephan.stilgenbauer{at}uniklinik-ulm.de.
A high incidence of autologous graft-versus-host-disease (auto-GvHD) was observed after an alemtuzumab containing conditioning regimen and autologous stem cell transplantation (auto-SCT) for CLL. Almost all surviving patients developed a skin rash (87%). In 7 patients (58%) a diagnosis of auto-GvHD was made (vs. 0% after TBI/Cy p=0.01). All patients with auto-GvHD needed immunosuppression and 3/7 were hospitalized because of GvHD. The median duration of GvHD was 517 days (range 60-867). Auto-GvHD was associated with an abnormally high CD4/CD8 ratio due to a severe depletion of CD8+ T-cells pointing to a potential pathomechanism. A high non-relapse-mortality led to the discontinuation of the trial. The current results do not support the use of high dose alemtuzumab combined with TBI and auto-SCT. However, the addition of alemtuzumab led to improved disease control at the molecular level and longer follow-up will show if the GvHD-like syndrome may contribute to prolonged MRD negativity.
