Clonal gammopathies following alemtuzumab-based reduced intensity conditioning haematopoietic stem cell transplantation: association with chronic graft-versus-host disease and improved overall survival

The presence of clonal gammopathies (CG) has been reported following both conventional myeloablative and autologous haematopoietic stem cell transplantation (HSCT). We monitored the occurrence of CG in a cohort of patients with myeloid malignancies receiving FBC (fludarabine-busulphan-alemtuzumab)-b...

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Published in:	Bone marrow transplantation (Basingstoke) Vol. 40; no. 8; pp. 747 - 752
Main Authors:	LIM, Z. Y, INGRAM, W, BRAND, R, AKTHARI, M, MILOJKOVIC, D, HO, A. Y. L, DEVEREUX, S, PAGLIUCA, A, DUARTE, R. F, MUFTI, G. J
Format:	Journal Article
Language:	English
Published:	Basingstoke Nature Publishing Group 01-10-2007
Subjects:	Adult Aged Alemtuzumab Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Antibodies, Monoclonal - administration & dosage Antibodies, Monoclonal - adverse effects Antibodies, Monoclonal, Humanized Antibodies, Neoplasm - administration & dosage Antibodies, Neoplasm - adverse effects Autografts Biological and medical sciences Bone marrow Bone marrow, stem cells transplantation. Graft versus host reaction Busulfan Causes of Complications and side effects Conditioning Electrophoresis Female Fludarabine Gammopathy Graft versus host disease Graft vs Host Disease - etiology Graft-versus-host reaction Health risks Hematopoietic Stem Cell Transplantation - adverse effects Hematopoietic stem cells Humans Immunoglobulin G Infections Male Medical sciences Middle Aged Monoclonal antibodies Monoclonal gammopathies Monoclonal Gammopathy of Undetermined Significance - etiology Multivariate analysis Prospective Studies Serum proteins Stem cell transplantation Stem cells Survival Survival Analysis Transfusions. Complications. Transfusion reactions. Cell and gene therapy Transplantation Transplantation Conditioning United Kingdom Immunopathology gammopathies Hematology Chronic disease Stem cell Intensity Hematopoietic cell Homograft Graft versus host reaction Alemtuzumab Monoclonal antibody Non myeloablative treatment Survival Immunomodulator Graft Immunosuppressive agent allogeneic transplantation reduced intensity
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Summary:	The presence of clonal gammopathies (CG) has been reported following both conventional myeloablative and autologous haematopoietic stem cell transplantation (HSCT). We monitored the occurrence of CG in a cohort of patients with myeloid malignancies receiving FBC (fludarabine-busulphan-alemtuzumab)-based reduced intensity conditioned (RIC) HSCT, and assessed its correlation with infections, graft-versus-host disease (GvHD) and survival. Serial serum protein electrophoresis was analysed in a total of 138 patients and CG were detected in 49 patients (36%). The predominant Ig isotype was IgG (82%). There was no difference in the incidence of viral infections between patient groups. However, patients with gammopathies were more likely to have had prior chronic GvHD (OR 2.7, 95% CI 1.3-5.5, P<0.001). On multivariate analysis, the only factors that were found to influence overall survival (OS) were presence of gammopathies, which was associated with an improved OS (OR 0.35 95% CI 0.14-0.86, P=0.02) as well as disease stage, patients with advanced disease having a higher risk of death (OR 2.20 95% CI 1.18-4.11, P=0.02). Disease stage was the only variable that influenced relapse incidence on multivariate analysis (OR 4.22 95% CI 1.82-9.78, P<0.01). Clonal gammopathies are a frequent but benign occurrence following alemtuzumab-based RIC HSCT, and their appearance may define a group of patients with a favourable overall outcome.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0268-3369 1476-5365
DOI:	10.1038/sj.bmt.1705805