Outcomes of transplantation with partial T-cell depletion of matched or mismatched unrelated or partially matched related donor bone marrow in children and adolescents with leukemias
Graft-versus-host disease (GVHD) remains a major barrier to successful hematopoietic stem cell transplant for patients who lack a matched related donor. Partial T-cell depletion (TCD) of the graft may decrease the risk of severe GVHD with unrelated donors (URD) and partially matched related donors (...
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| Veröffentlicht in: | Bone marrow transplantation (Basingstoke) 2005-01, Vol.35 (2), p.151-158 |
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| creator | BUNIN, N APLENC, R LEAHEY, A MAGIRA, E GRUPP, S PIERSON, G MONOS, D |
| description | Graft-versus-host disease (GVHD) remains a major barrier to successful hematopoietic stem cell transplant for patients who lack a matched related donor. Partial T-cell depletion (TCD) of the graft may decrease the risk of severe GVHD with unrelated donors (URD) and partially matched related donors (PMRD) while retaining an antileukemic effect. We analyzed our experience using URD and PMRD for pediatric patients with leukemias from 1990 to 2001. A subgroup of 'matched' URD donor pairs was retrospectively analyzed for high-resolution class I. Partial TCD was accomplished with monoclonal antibody T10B9 or OKT3 and complement. There were 76 URD (45% matched) and 28 PMRD recipients. Event-free survival (EFS) was 38.3%, and overall survival (OS) 45.1% at 3 years. On multivariate analysis, there was no difference in survival based upon marrow source, but nonrelapse mortality was higher with the use of PMRD. Relapse occurred in 6% of ALL patients, and 22.8% of AML/MDS patients. Grades III-IV GVHD was observed in only 6.7% of patients. Partial TCD allows use of matched or mismatched URD, or PMRD with little mortality from GVHD, durable engraftment, and no increase in relapse risk. |
| doi_str_mv | 10.1038/sj.bmt.1704754 |
| format | Article |
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Partial T-cell depletion (TCD) of the graft may decrease the risk of severe GVHD with unrelated donors (URD) and partially matched related donors (PMRD) while retaining an antileukemic effect. We analyzed our experience using URD and PMRD for pediatric patients with leukemias from 1990 to 2001. A subgroup of 'matched' URD donor pairs was retrospectively analyzed for high-resolution class I. Partial TCD was accomplished with monoclonal antibody T10B9 or OKT3 and complement. There were 76 URD (45% matched) and 28 PMRD recipients. Event-free survival (EFS) was 38.3%, and overall survival (OS) 45.1% at 3 years. On multivariate analysis, there was no difference in survival based upon marrow source, but nonrelapse mortality was higher with the use of PMRD. Relapse occurred in 6% of ALL patients, and 22.8% of AML/MDS patients. Grades III-IV GVHD was observed in only 6.7% of patients. Partial TCD allows use of matched or mismatched URD, or PMRD with little mortality from GVHD, durable engraftment, and no increase in relapse risk.</description><identifier>ISSN: 0268-3369</identifier><identifier>EISSN: 1476-5365</identifier><identifier>DOI: 10.1038/sj.bmt.1704754</identifier><identifier>PMID: 15531896</identifier><identifier>CODEN: BMTRE9</identifier><language>eng</language><publisher>Basingstoke: Nature Publishing Group</publisher><subject>Adolescent ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anticancer properties ; Biological and medical sciences ; Bone marrow ; Bone marrow transplantation ; Bone Marrow Transplantation - adverse effects ; Bone Marrow Transplantation - methods ; Bone Marrow Transplantation - mortality ; Bone marrow, stem cells transplantation. Graft versus host reaction ; Child ; Children ; Depletion ; Donors ; Graft Survival ; Graft versus host disease ; Graft vs Host Disease - mortality ; Graft vs Host Disease - prevention & control ; Graft-versus-host reaction ; Hematologic and hematopoietic diseases ; Hematopoietic stem cells ; Histocompatibility ; Histocompatibility Testing - methods ; Humans ; Leukemia ; Leukemia - mortality ; Leukemia - therapy ; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis ; Lymphocyte Depletion - methods ; Lymphocyte Depletion - mortality ; Lymphocytes T ; Medical sciences ; Monoclonal antibodies ; Mortality ; Multivariate analysis ; Patients ; Pediatrics ; Recurrence ; Stem cell transplantation ; Stem cells ; Subgroups ; Survival ; Survival Analysis ; T-Lymphocytes ; Tissue Donors ; Transfusions. Complications. Transfusion reactions. Cell and gene therapy ; Transplantation ; Transplantation Immunology ; Transplants & implants ; Treatment Outcome</subject><ispartof>Bone marrow transplantation (Basingstoke), 2005-01, Vol.35 (2), p.151-158</ispartof><rights>2005 INIST-CNRS</rights><rights>Copyright Nature Publishing Group Jan 2005</rights><rights>Nature Publishing Group 2005.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-6240052657d01b1675fa0e32638fffeb0e4a6408ebc9b851dcfb4f4c84c03dee3</citedby><cites>FETCH-LOGICAL-c400t-6240052657d01b1675fa0e32638fffeb0e4a6408ebc9b851dcfb4f4c84c03dee3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,4012,27906,27907,27908</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16468050$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15531896$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>BUNIN, N</creatorcontrib><creatorcontrib>APLENC, R</creatorcontrib><creatorcontrib>LEAHEY, A</creatorcontrib><creatorcontrib>MAGIRA, E</creatorcontrib><creatorcontrib>GRUPP, S</creatorcontrib><creatorcontrib>PIERSON, G</creatorcontrib><creatorcontrib>MONOS, D</creatorcontrib><title>Outcomes of transplantation with partial T-cell depletion of matched or mismatched unrelated or partially matched related donor bone marrow in children and adolescents with leukemias</title><title>Bone marrow transplantation (Basingstoke)</title><addtitle>Bone Marrow Transplant</addtitle><description>Graft-versus-host disease (GVHD) remains a major barrier to successful hematopoietic stem cell transplant for patients who lack a matched related donor. Partial T-cell depletion (TCD) of the graft may decrease the risk of severe GVHD with unrelated donors (URD) and partially matched related donors (PMRD) while retaining an antileukemic effect. We analyzed our experience using URD and PMRD for pediatric patients with leukemias from 1990 to 2001. A subgroup of 'matched' URD donor pairs was retrospectively analyzed for high-resolution class I. Partial TCD was accomplished with monoclonal antibody T10B9 or OKT3 and complement. There were 76 URD (45% matched) and 28 PMRD recipients. Event-free survival (EFS) was 38.3%, and overall survival (OS) 45.1% at 3 years. On multivariate analysis, there was no difference in survival based upon marrow source, but nonrelapse mortality was higher with the use of PMRD. Relapse occurred in 6% of ALL patients, and 22.8% of AML/MDS patients. Grades III-IV GVHD was observed in only 6.7% of patients. Partial TCD allows use of matched or mismatched URD, or PMRD with little mortality from GVHD, durable engraftment, and no increase in relapse risk.</description><subject>Adolescent</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anticancer properties</subject><subject>Biological and medical sciences</subject><subject>Bone marrow</subject><subject>Bone marrow transplantation</subject><subject>Bone Marrow Transplantation - adverse effects</subject><subject>Bone Marrow Transplantation - methods</subject><subject>Bone Marrow Transplantation - mortality</subject><subject>Bone marrow, stem cells transplantation. Graft versus host reaction</subject><subject>Child</subject><subject>Children</subject><subject>Depletion</subject><subject>Donors</subject><subject>Graft Survival</subject><subject>Graft versus host disease</subject><subject>Graft vs Host Disease - mortality</subject><subject>Graft vs Host Disease - prevention & control</subject><subject>Graft-versus-host reaction</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Hematopoietic stem cells</subject><subject>Histocompatibility</subject><subject>Histocompatibility Testing - methods</subject><subject>Humans</subject><subject>Leukemia</subject><subject>Leukemia - mortality</subject><subject>Leukemia - therapy</subject><subject>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</subject><subject>Lymphocyte Depletion - methods</subject><subject>Lymphocyte Depletion - mortality</subject><subject>Lymphocytes T</subject><subject>Medical sciences</subject><subject>Monoclonal antibodies</subject><subject>Mortality</subject><subject>Multivariate analysis</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Recurrence</subject><subject>Stem cell transplantation</subject><subject>Stem cells</subject><subject>Subgroups</subject><subject>Survival</subject><subject>Survival Analysis</subject><subject>T-Lymphocytes</subject><subject>Tissue Donors</subject><subject>Transfusions. Complications. Transfusion reactions. 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Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anticancer properties</topic><topic>Biological and medical sciences</topic><topic>Bone marrow</topic><topic>Bone marrow transplantation</topic><topic>Bone Marrow Transplantation - adverse effects</topic><topic>Bone Marrow Transplantation - methods</topic><topic>Bone Marrow Transplantation - mortality</topic><topic>Bone marrow, stem cells transplantation. Graft versus host reaction</topic><topic>Child</topic><topic>Children</topic><topic>Depletion</topic><topic>Donors</topic><topic>Graft Survival</topic><topic>Graft versus host disease</topic><topic>Graft vs Host Disease - mortality</topic><topic>Graft vs Host Disease - prevention & control</topic><topic>Graft-versus-host reaction</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Hematopoietic stem cells</topic><topic>Histocompatibility</topic><topic>Histocompatibility Testing - methods</topic><topic>Humans</topic><topic>Leukemia</topic><topic>Leukemia - mortality</topic><topic>Leukemia - therapy</topic><topic>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</topic><topic>Lymphocyte Depletion - methods</topic><topic>Lymphocyte Depletion - mortality</topic><topic>Lymphocytes T</topic><topic>Medical sciences</topic><topic>Monoclonal antibodies</topic><topic>Mortality</topic><topic>Multivariate analysis</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Recurrence</topic><topic>Stem cell transplantation</topic><topic>Stem cells</topic><topic>Subgroups</topic><topic>Survival</topic><topic>Survival Analysis</topic><topic>T-Lymphocytes</topic><topic>Tissue Donors</topic><topic>Transfusions. Complications. Transfusion reactions. 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Partial T-cell depletion (TCD) of the graft may decrease the risk of severe GVHD with unrelated donors (URD) and partially matched related donors (PMRD) while retaining an antileukemic effect. We analyzed our experience using URD and PMRD for pediatric patients with leukemias from 1990 to 2001. A subgroup of 'matched' URD donor pairs was retrospectively analyzed for high-resolution class I. Partial TCD was accomplished with monoclonal antibody T10B9 or OKT3 and complement. There were 76 URD (45% matched) and 28 PMRD recipients. Event-free survival (EFS) was 38.3%, and overall survival (OS) 45.1% at 3 years. On multivariate analysis, there was no difference in survival based upon marrow source, but nonrelapse mortality was higher with the use of PMRD. Relapse occurred in 6% of ALL patients, and 22.8% of AML/MDS patients. Grades III-IV GVHD was observed in only 6.7% of patients. Partial TCD allows use of matched or mismatched URD, or PMRD with little mortality from GVHD, durable engraftment, and no increase in relapse risk.</abstract><cop>Basingstoke</cop><pub>Nature Publishing Group</pub><pmid>15531896</pmid><doi>10.1038/sj.bmt.1704754</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anticancer properties Biological and medical sciences Bone marrow Bone marrow transplantation Bone Marrow Transplantation - adverse effects Bone Marrow Transplantation - methods Bone Marrow Transplantation - mortality Bone marrow, stem cells transplantation. Graft versus host reaction Child Children Depletion Donors Graft Survival Graft versus host disease Graft vs Host Disease - mortality Graft vs Host Disease - prevention & control Graft-versus-host reaction Hematologic and hematopoietic diseases Hematopoietic stem cells Histocompatibility Histocompatibility Testing - methods Humans Leukemia Leukemia - mortality Leukemia - therapy Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis Lymphocyte Depletion - methods Lymphocyte Depletion - mortality Lymphocytes T Medical sciences Monoclonal antibodies Mortality Multivariate analysis Patients Pediatrics Recurrence Stem cell transplantation Stem cells Subgroups Survival Survival Analysis T-Lymphocytes Tissue Donors Transfusions. Complications. Transfusion reactions. Cell and gene therapy Transplantation Transplantation Immunology Transplants & implants Treatment Outcome |
| title | Outcomes of transplantation with partial T-cell depletion of matched or mismatched unrelated or partially matched related donor bone marrow in children and adolescents with leukemias |
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