Ex vivo and in vivo T cell-depleted allogeneic stem cell transplantation in patients with acute myeloid leukemia in first complete remission resulted in similar overall survival: on behalf of the ALWP of the EBMT and the MSKCC

Journal of Hematology & Oncology

Miguel-Angel Perales¹  Esperanza B. Papadopoulos¹  Molly Maloy¹  Hugo Castro-Malaspina¹  Christina Cho¹  Sergio Giralt¹  Ann A. Jakubowski¹  Richard O’Reilly²  Edouard Forcade³  Yosr Hicheri⁴  Arnon Nagler⁵  Didier Blaise⁶  Corentin Orvain⁷  Myriam Labopin⁸  Mohamad Mohty⁸  Florent Malard⁸  Liisa Volin⁹  Jakob Passweg^1,10 

[1] Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center;Bone Marrow Transplant Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center;CHU Bordeaux, Hôpital Haut-leveque;Département d’Hématologie Clinique, CHU Lapeyronie;EBMT Paris Study Office/CEREST-TC;Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes;Service des Maladies du Sang, CHRU;Service d’Hématologie Clinique et Thérapie Cellulaire, AP-HP, Hôpital Saint-Antoine;Stem Cell Transplantation Unit, HUCH Comprehensive Cancer Center;University Hospital, Hematology;

关键词: Acute myeloid leukemia;    T cell depletion;    CD34-selected graft;    Antithymocyte globulin;    Allogeneic hematopoietic cell transplantation;   

DOI  :  10.1186/s13045-018-0668-3

来源: DOAJ

【 摘 要 】

Abstract Background Graft-versus-host disease (GVHD) is one of the leading causes of non-relapse mortality and morbidity after allogeneic hematopoietic stem cell transplantation (allo-HCT). Methods We evaluated the outcomes of two well-established strategies used for GVHD prevention: in vivo T cell depletion using antithymocyte globulin (ATG) and ex vivo T cell depletion using a CD34-selected (CD34+) graft. A total of 525 adult patients (363 ATG, 162 CD34+) with intermediate or high-risk cytogenetics acute myeloid leukemia (AML) in first complete remission (CR1) were included. Patients underwent myeloablative allo-HCT using matched related or unrelated donors. Results Two-year overall survival estimate was 69.9% (95% CI, 58.5–69.4) in the ATG group and 67.6% (95% CI, 60.3–74.9) in the CD34+ group (p = 0.31). The cumulative incidence of grade II–IV acute GVHD and chronic GVHD was higher in the ATG cohort [HR 2.0 (95% CI 1.1–3.7), p = 0.02; HR 15.1 (95% CI 5.3–42.2), p < 0.0001]. Parameters associated with a lower GVHD-free relapse-free survival (GRFS) were ATG [HR 1.6 (95% CI 1.1–2.2), p = 0.006], adverse cytogenetic [HR 1.7 (95% CI 1.3–2.2), p = 0.0004], and the use of an unrelated donor [HR 1.4 (95% CI 1.0–1.9), p = 0.02]. There were no statistical differences between ATG and CD34+ in terms of relapse [HR 1.52 (95% CI 0.96–2.42), p = 0.07], non-relapse mortality [HR 0.96 (95% CI 0.54–1.74), p = 0.90], overall survival [HR 1.43 (95% CI 0.97–2.11), p = 0.07], and leukemia-free survival [HR 1.25 (95% CI 0.88–1.78), p = 0.21]. Significantly, more deaths related to infection occurred in the CD34+ group (16/52 vs. 19/112, p = 0.04). Conclusions These data suggest that both ex vivo CD34-selected and in vivo ATG T cell depletion are associated with a rather high OS and should be compared in a prospective randomized trial.

【 授权许可】

Unknown