Long-term follow-up of myeloablative allogeneic stem cell transplantation using Campath 'in the bag'as T-cell depletion: the Leiden experience

RMY Barge, CWJ Starrenburg… - Bone marrow …, 2006 - nature.com
RMY Barge, CWJ Starrenburg, JHF Falkenburg, WE Fibbe, EW Marijt, R Willemze
Bone marrow transplantation, 2006nature.com
Graft-versus-host disease (GVHD) is a major cause of mortality and morbidity after
allogeneic stem cell transplantation (alloSCT) but can be prevented by removing T-
lymphocytes from the graft. Campath (anti-CD52) antibodies have been widely used in vivo
for T-cell depletion following conventional and reduced intensity conditioning regimens. The
use of Campath in vivo was associated with a significant reduction in GVHD but at the cost of
impaired immune reconstitution. We evaluated the long-term outcome of 73 myeloablative …
Abstract
Graft-versus-host disease (GVHD) is a major cause of mortality and morbidity after allogeneic stem cell transplantation (alloSCT) but can be prevented by removing T-lymphocytes from the graft. Campath (anti-CD52) antibodies have been widely used in vivo for T-cell depletion following conventional and reduced intensity conditioning regimens. The use of Campath in vivo was associated with a significant reduction in GVHD but at the cost of impaired immune reconstitution. We evaluated the long-term outcome of 73 myeloablative allogeneic stem cell transplants with HLA-identical sibling donors using Campath ‘in the bag’as method of in vitro T-cell depletion. All patients engrafted and hematopoietic recovery was uneventful, resulting in a median of 99% donor chimerism at 3 months after alloSCT. Cytomegalovirus (CMV) reactivation occurred in 53% of the patients. No CMV disease was observed probably as a result of pre-emptive (val) ganciclovir treatment. The incidence of aGVHD was low (22% grade II). No grades III–IV aGVHD was observed and extensive chronic GVHD (cGVHD) occurred in 19% of the patients. The low incidence of GVHD and successful pre-emptive antiviral therapy resulted in low TRM of 8%. Sixteen patients died due to disease relapse after alloSCT, resulting in an overall survival of 48% at 5-years after alloSCT.
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