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Blood, 15 December 2007, Vol. 110, No. 13, pp. 4552-4559.
Prepublished online as a Blood First Edition Paper on August 23, 2007; DOI 10.1182/blood-2007-06-093880.
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Submitted June 6, 2007
Accepted August 2, 2007
T-cell depleted stem cell transplantation for adults with hematologic malignancies: sustained engraftment of HLA-matched related donor grafts without the use of anti-thymocyte globulin
Ann A Jakubowski*, Trudy N. Small, James W. Young, Nancy A Kernan, Hugo Castro-Malaspina, Katharine C. Hsu, Miguel-Angel Perales, Nancy Collins, Christine Cisek, Michelle Chiu, Marcel R.M. van den Brink, Richard J. O'Reilly, and Esperanza B. Papadopoulos
Department of Medicine, Division of Hematology-Oncology, Memorial Sloan Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY
Department of Pediatrics, Division of Hematology-Oncology, Memorial Sloan Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY
Dept of Clinical Laboratories, Div of Hematology-Oncology, Memorial Sloan Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY
* Corresponding author; email: jakubowa{at}mskcc.org.
Antithymocyte globulin (ATG) has been employed in allogeneic stem cell transplantation to prevent graft rejection and graft versus host disease (GvHD). Its use, however, has been associated with delayed T cell reconstitution and prolonged susceptibility to opportunistic infections (OI) especially in patients undergoing T cell depleted (TCD) transplantation. Recently, a prospective trial was conducted in 52 adult patients (median age 47 years) with various hematologic malignancies undergoing TCD transplantation from HLA matched related donors without the use of ATG. The cytoreductive regimen consisted of hyperfractionated total body irradiation (HFTBI), thiotepa and fludarabine. The preferred source of the graft was peripheral blood stem cells (PBSC). No additional graft rejection or GvHD prophylaxis was given. All evaluable patients engrafted without any immune mediated graft rejections. Disease free survival (DFS) at 3 years was 61% in all patients, and 70% in patients with standard risk disease. Acute GvHD was limited to grade II in 8% and chronic GvHD in 9% of patients. Life-threatening OI occurred in 3 of 52 patients and was fatal in one. This study demonstrates durable engraftment with a low incidence of GvHD despite the lack of ATG, as well as the curative potential of this regimen.
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