The New England Journal of Medicine
e-mail icon  FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |    Advanced Search
Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe
 
Original Article
PreviousPrevious
Volume 339:1186-1193 October 22, 1998 Number 17
NextNext

Treatment of High-Risk Acute Leukemia with T-Cell–Depleted Stem Cells from Related Donors with One Fully Mismatched HLA Haplotype
Franco Aversa, M.D., Antonio Tabilio, M.D., Andrea Velardi, M.D., Isabel Cunningham, M.D., Adelmo Terenzi, M.D., Franca Falzetti, M.D., Loredana Ruggeri, M.D., Giuliana Barbabietola, M.D., Cynthia Aristei, M.D., Paolo Latini, M.D., Yair Reisner, Ph.D., Massimo F. Martelli, M.D., Rita Felicini, M.D., Flavio Falcinelli, M.D., Alessandra Carotti, M.D., Katia Perruccio, M.D., Stelvio Ballanti, M.D., Antonella Santucci, M.D., and Cesare Gambelunghe, M.D.

 Sign up for free e-toc
 

This Article
-Full Text
- PDF

Commentary
-Editorial
 by van Rood, J. J.
-Letters

Tools and Services
-Add to Personal Archive
-Add to Citation Manager
-Notify a Friend
-E-mail When Cited

More Information
-PubMed Citation
ABSTRACT

Background In this study we tried to achieve successful transplantation in patients with acute leukemia with the use of hematopoietic stem cells from donors who shared only one HLA haplotype with the recipient (a "full-haplotype mismatch"). To prevent graft failure, large doses of T-cell–depleted hematopoietic stem cells were transplanted after a conditioning regimen of enhanced myeloablation and immunosuppression was administered to the recipient.

Methods Forty-three patients with high-risk acute leukemia who were scheduled for transplantation received total-body irradiation, thiotepa, fludarabine, and antithymocyte globulin. The graft consisted of peripheral-blood progenitor cells that had been mobilized in the donor with recombinant granulocyte colony-stimulating factor and also, in 28 cases, bone marrow. Bone marrow from the donor was depleted of T lymphocytes by processing with soybean agglutinin and E-rosetting. T-cell depletion of peripheral-blood mononuclear cells was achieved by E-rosetting followed by positive selection of CD34+ cells. No post-transplantation prophylaxis against graft-versus-host disease (GVHD) was administered.

Results In all the patients, full donor-type engraftment was achieved. In none of the patients who could be evaluated did acute or chronic GVHD develop. Regimen-related toxicity was minimal. Eleven of the 23 patients with acute lymphoblastic leukemia had a relapse, as did 2 of the 20 patients with acute myeloid leukemia. Transplantation-related mortality was 40 percent. After a median follow-up of 18 months (range, 8 to 30), 12 of the 43 patients were alive and free of disease. All surviving patients had a good quality of life.

Conclusions The main limitations of transplantation of bone marrow from donors who are matched with the recipient for only one HLA haplotype — GVHD and graft failure — can be overcome. Since most patients have a relative with one haplotype mismatch, advances in this method will increase the availability of hematopoietic-cell transplantation as curative therapy for acute 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.

Full Text of this Article


Related Letters:

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

This article has been cited by other articles:



HOME  |  SUBSCRIBE  |  SEARCH  |  CURRENT ISSUE  |  PAST ISSUES  |  COLLECTIONS  |  PRIVACY  |  HELP  |  beta.nejm.org

Comments and questions? Please contact us.

The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved.