C. Herrera et al., Prevention of graft-versus-host disease in high risk patients by depletionof CD4(+) and reduction of CD8(+) lymphocytes in the marrow graft, BONE MAR TR, 23(5), 1999, pp. 443-450
Citations number
42
Categorie Soggetti
Hematology,"Medical Research Diagnosis & Treatment
From March 1994 to September 1997, 30 patients with hematological malignanc
ies (12 ANLL, 10 CML, four ALL and four multiple myeloma) received HLA-iden
tical allogeneic bone marrow transplants with the marrow graft selectively
depleted of CD4(+) lymphocytes and the CD8(+) cell content adjusted to 1 x
10(6)/kg, Total depletion of CD4(+) and partial depletion of CD8(+) lymphoc
ytes was carried out by an immunomagnetical method. All patients were consi
dered as having high risk for developing GVHD by at least one of the follow
ing criteria: patient age >35 years; donor age >35 years; donor multiparity
or marrow from an unrelated donor. Twenty-four cases received marrow from
an identical sibling and six from an unrelated donor. In order to assess th
e role of methotrexate (MTX) in addition to cyclosporin A (CsA) after trans
plant, patients were randomly assigned to received either CsA alone (n = 15
) or CsA plus a short course of MTX (n = 15). No case of primary graft fail
ure was observed, but two patients developed late graft failure. Six patien
ts presented grade II acute GVHD and no case of severe III-IV GVHD was seen
. The actuarial probability of developing grade II-IV acute GVHD was 25.9 /- 9.6% for the entire population, Patients receiving post-transplant CsA MTX had significantly less probability of acute GVHD than those receiving
CsA exclusively (6.7 +/- 6.4% vs 50.5 +/- 17.8 %, P = 0.03) and the schedul
e of post-transplant immunosuppression was the only factor associated with
the incidence of acute GVHD in a multivariate analysis. The actuarial incid
ence of chronic GVHD for the entire population was 31.8 +/- 12.5, and there
was no significant difference between both groups with additional prophyla
xis, Four patients with CML and three with ANLL relapsed: the actuarial pro
bability of remaining in complete remission for all patients was 53.6 +/- 1
7.3%. For patients with acute leukemia, the probability of remaining in com
plete remission did not differ significantly between those transplanted in
first complete remission and those receiving a transplant in more advanced
phases of the disease (87.5 +/- 11.6% vs 72.9 +/- 16.5%; P = 0.44). The inc
idence of mixed chimerism assessed by PCR was 34%, Nineteen patients are al
ive between 2 and 43 months post-transplant, the probability of overall sur
vival being 57.8 +/- 10.4%, Our data indicate that this method of selective
T cell depletion is very effective in preventing acute GVHD in high risk p
atients, particularly when used in combination with post-transplant CsA + M
TX.