Background In this study we tried to achieve successful transplantationin patients with acute leukemia with the use of hematopoieticstem cells from donors who shared only one HLA haplotype withthe recipient (a "full-haplotype mismatch"). To prevent graftfailure, large doses of T-celldepleted hematopoieticstem cells were transplanted after a conditioning regimen ofenhanced myeloablation and immunosuppression was administeredto the recipient.
Methods Forty-three patients with high-risk acute leukemia whowere scheduled for transplantation received total-body irradiation,thiotepa, fludarabine, and antithymocyte globulin. The graftconsisted of peripheral-blood progenitor cells that had beenmobilized in the donor with recombinant granulocyte colony-stimulatingfactor and also, in 28 cases, bone marrow. Bone marrow fromthe donor was depleted of T lymphocytes by processing with soybeanagglutinin and E-rosetting. T-cell depletion of peripheral-bloodmononuclear cells was achieved by E-rosetting followed by positiveselection of CD34+ cells. No post-transplantation prophylaxisagainst graft-versus-host disease (GVHD) was administered.
Results In all the patients, full donor-type engraftment wasachieved. In none of the patients who could be evaluated didacute or chronic GVHD develop. Regimen-related toxicity wasminimal. Eleven of the 23 patients with acute lymphoblasticleukemia had a relapse, as did 2 of the 20 patients with acutemyeloid leukemia. Transplantation-related mortality was 40 percent.After a median follow-up of 18 months (range, 8 to 30), 12 ofthe 43 patients were alive and free of disease. All survivingpatients had a good quality of life.
Conclusions The main limitations of transplantation of bonemarrow from donors who are matched with the recipient for onlyone HLA haplotype GVHD and graft failure canbe overcome. Since most patients have a relative with one haplotypemismatch, advances in this method will increase the availabilityof hematopoietic-cell transplantation as curative therapy foracute leukemia.
Source Information
From the Hematopoietic Stem Cell Transplant Program, Department of Internal and Experimental Medicine (F.A., A. Tabilio, A.V., I.C., A. Terenzi, F.F., L.R., G.B., M.F.M.), and the Department of Radiotherapy (C.A., P.L.), University of Perugia, Perugia, Italy; and the Department of Immunology, Weizmann Institute, Rehovot, Israel (Y.R.). Other authors were Rita Felicini, M.D., Flavio Falcinelli, M.D., Alessandra Carotti, M.D., Katia Perruccio, M.D., Stelvio Ballanti, M.D., and Antonella Santucci, M.D. (Department of Internal and Experimental Medicine, University of Perugia), and Cesare Gambelunghe, M.D. (Blood Bank, Azienda Ospedaliera, Perugia).
Address reprint requests to Dr. Aversa at the Istituto di Ematologia, Università di Perugia, Policlinico Monteluce, Via Brunamonti, 06100 Perugia, Italy.
Hematopoietic Stem-Cell Transplantation for Acute Leukemia
Eiermann T. H., van Bekkum D. W., Vriesendorp H. M., Machida U., Kami M., Hirai H., Bolan C. D., Leitman S. F., Sasazuki T., Juji T., Kodera Y., Aversa F., Martelli M. F., Reisner Y.
Extract |
Full Text
N Engl J Med 1999;
340:809-812, Mar 11, 1999.
Correspondence
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