T-cell depletion of bone marrow transplants for leukemia from donors other than HLA-identical siblings: advantage of T-cell antibodies with narrow specificities

• Published in: Blood Vol. 95; no. 12; pp. 3996 - 4003
• Main Authors: CHAMPLIN, R. E, PASSWEG, J. R, GOLDMAN, J. M, GRATWOHL, A, GORDON-SMITH, E. C, HENSLEE-DOWNEY, P. J, HERZIG, R. H, KLEIN, J. P, MARMONT, A. M, O'REILLY, R. J, RINGDEN, O, SLAVIN, S, ZHANG, M.-J, SOBOCINSKI, K. A, SPECK, B, WEINER, R. S, HOROWITZ, M. M, ROWLINGS, P. A, PELZ, C. J, ATKINSON, K. A, BARRETT, A. J, CAHN, J.-Y, DROBYSKI, W. R, GALE, R. P
• Format: Journal Article
• Language: English
• Published: Washington, DC The Americain Society of Hematology 15-06-2000
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antibody Specificity; Biological and medical sciences; Bone Marrow Transplantation - immunology; Bone Marrow Transplantation - mortality; Bone marrow, stem cells transplantation. Graft versus host reaction; Child; Child, Preschool; Cyclosporine - therapeutic use; Follow-Up Studies; Graft vs Host Disease - prevention & control; Histocompatibility Testing; HLA Antigens - immunology; Humans; Immunosuppressive Agents - therapeutic use; Infant; Isoantibodies - immunology; Leukemia - immunology; Leukemia - mortality; Leukemia - therapy; Lymphocyte Depletion; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Nuclear Family; Registries; Retrospective Studies; Survival Rate; T-Lymphocytes - immunology; Tissue Donors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation, Homologous; Human; Incompatibility; HLA-System; Prognosis; Antibody; Unrelated donor; Acute; Major histocompatibility system; Related donor; Homograft; Malignant hemopathy; Myeloproliferative syndrome; Chronic; Specificity; Depletion; Treatment; Lymphoproliferative syndrome; Chronic myelocytic leukemia; T-Lymphocyte; Bone marrow; Graft; Acute lymphocytic leukemia; Acute myelocytic leukemia
• ISSN: 0006-4971; 1528-0020

T-cell depletion of donor marrow decreases graft-versus-host disease resulting from transplants from unrelated and human leukocyte antigen (HLA)-mismatched related donors. However, there are diverse strategies for T-cell-depleted transplantation, and it is uncertain whether any improve leukemia-free survival (LFS). To compare strategies for T-cell-depleted alternative donor transplants and to compare T-cell depleted with non-T-cell-depleted transplants, we studied 870 patients with leukemia who received T-cell-depleted transplants from unrelated or HLA-mismatched related donors from 1982 to 1994. Outcomes were compared with those of 998 non-T-cell-depleted transplants. We compared LFS using different strategies for T-cell-depleted transplantation considering T-cell depletion technique, intensity of pretransplant conditioning, and posttransplant immune suppression using proportional hazards regression to adjust for other prognostic variables. Five categories of T-cell depletion techniques were considered: narrow-specificity antibodies, broad-specificity antibodies, Campath antibodies, elutriation, and lectins. Strategies resulting in similar LFS were pooled to compare T-cell-depleted with non-T-cell-depleted transplants. Recipients of transplants T-cell depleted by narrow-specificity antibodies had lower treatment failure risk (higher LFS) than recipients of transplants T-cell depleted by other techniques. Compared with non-T-cell-depleted transplants (5-year probability +/- 95% confidence interval [CI] of LFS, 31% +/- 4%), 5-year LFS was 29% +/- 5% (P = NS) after transplants T-cell depleted by narrow-specificity antibodies and 16% +/- 4% (P <.0001) after transplants T-cell depleted by other techniques. After alternative donor transplantation, T-cell depletion of donor marrow by narrow-specificity antibodies resulted in LFS rates that were higher than those for transplants T-cell depleted using other techniques but similar to those for non-T-cell-depleted transplants. (Blood. 2000;95:3996-4003)