Long-term follow-up of myeloablative allogeneic stem cell transplantation using Campath "in the bag" as T-cell depletion: the Leiden experience

Bone Marrow Transplant. 2006 Jun;37(12):1129-34. doi: 10.1038/sj.bmt.1705385.

Abstract

Graft-versus-host disease (GVHD) is a major cause of mortality and morbidity after allogeneic stem cell transplantation (alloSCT) but can be prevented by removing T-lymphocytes from the graft. Campath (anti-CD52) antibodies have been widely used in vivo for T-cell depletion following conventional and reduced intensity conditioning regimens. The use of Campath in vivo was associated with a significant reduction in GVHD but at the cost of impaired immune reconstitution. We evaluated the long-term outcome of 73 myeloablative allogeneic stem cell transplants with HLA-identical sibling donors using Campath "in the bag" as method of in vitro T-cell depletion. All patients engrafted and hematopoietic recovery was uneventful, resulting in a median of 99% donor chimerism at 3 months after alloSCT. Cytomegalovirus (CMV) reactivation occurred in 53% of the patients. No CMV disease was observed probably as a result of pre-emptive (val)ganciclovir treatment. The incidence of aGVHD was low (22% grade II). No grades III-IV aGVHD was observed and extensive chronic GVHD (cGVHD) occurred in 19% of the patients. The low incidence of GVHD and successful pre-emptive antiviral therapy resulted in low TRM of 8%. Sixteen patients died due to disease relapse after alloSCT, resulting in an overall survival of 48% at 5-years after alloSCT.

MeSH terms

  • Adult
  • Alemtuzumab
  • Antibodies, Monoclonal / administration & dosage*
  • Antibodies, Monoclonal, Humanized
  • Antibodies, Neoplasm / administration & dosage*
  • Antineoplastic Agents / administration & dosage*
  • Antiviral Agents / administration & dosage
  • Cytomegalovirus Infections / etiology
  • Cytomegalovirus Infections / mortality
  • Cytomegalovirus Infections / prevention & control
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Ganciclovir / administration & dosage
  • Graft vs Host Disease / etiology
  • Graft vs Host Disease / mortality
  • Graft vs Host Disease / prevention & control*
  • Humans
  • Lymphocyte Depletion* / methods
  • Lymphoproliferative Disorders / complications
  • Lymphoproliferative Disorders / mortality
  • Lymphoproliferative Disorders / therapy*
  • Male
  • Middle Aged
  • Netherlands
  • Retrospective Studies
  • Stem Cell Transplantation* / adverse effects
  • Stem Cell Transplantation* / mortality
  • Transplantation Conditioning* / mortality
  • Transplantation, Homologous

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antibodies, Neoplasm
  • Antineoplastic Agents
  • Antiviral Agents
  • Alemtuzumab
  • Ganciclovir