An immunoablative regimen of fludarabine and cyclophosphamide prevents fully MHC-mismatched murine marrow graft rejection independent of GVHD

Biol Blood Marrow Transplant. 2000;6(2A):182-9. doi: 10.1016/s1083-8791(00)70041-3.

Abstract

The prevention of graft rejection in the setting of nonmyeloablative transplant approaches might be mediated by chemotherapy-induced host immunoablation and by the graft-promoting effects of graft-versus-host disease (GVHD). To evaluate whether host immunoablation alone might allow for alloengraftment, we developed an F1-into-parent murine marrow rejection model using host preparative regimens of lethal total body irradiation (TBI; 950 cGy), sublethal irradiation (600 cGy), or combinations of fludarabine (Flu) and cyclophosphamide (Cy). A preparative regimen selectivity index (SI) was calculated to determine whether host lymphocytes were preferentially depleted relative to myeloid cells (SI = number of host myeloid/number host T lymphoid cells remaining after preparative regimen administration). Saline-treated recipients were assigned an SI value of 1.0. Recipients of lethal TBI had reduced myeloid cells relative to T cells (SI = 0.6). In contrast, all Flu/Cy regimens preferentially depleted host T cells: recipients of Flu (100 mg/kg per day)/Cy (50 mg/kg per day) for 10 days (SI = 28.1); recipients of Flu (100 mg/kg per day)/Cy (100 mg/kg per day) for 10 days (SI = 64.1); and recipients of Flu (100 mg/kg per day)/Cy (50 mg/kg per day) for 19 or 27 days (SI = 74.6). The 10-day regimen of Flu/Cy (50 mg/kg per day) did not severely reduce host T cell numbers, nor did it prevent F1 marrow rejection (<1% chimerism, n = 14). In contrast, the 10-day regimen of Flu/Cy (100 mg/kg per day) reduced T-cell numbers below that of lethal TBI recipients and prevented F1 marrow rejection (11.4% chimerism, n = 15); donor chimerism was predominant in lymphoid cells and was stable through day 240 post-BMT. Additionally, the 19- or 27-day regimen of Flu/Cy, which most selectively depleted host T cells, also prevented F1 marrow rejection (6.3% chimerism, n = 15). These results therefore demonstrate that optimized Flu-containing, immunoablative preparative regimens can prevent fully MHC-disparate marrow rejection independent of GVHD.

Publication types

  • Comparative Study

MeSH terms

  • Animals
  • Antineoplastic Agents / therapeutic use
  • Bone Marrow Transplantation / adverse effects*
  • Bone Marrow Transplantation / immunology
  • CD4-Positive T-Lymphocytes / drug effects
  • CD4-Positive T-Lymphocytes / radiation effects
  • CD8-Positive T-Lymphocytes / drug effects
  • CD8-Positive T-Lymphocytes / radiation effects
  • Cell Lineage
  • Cyclophosphamide / pharmacology*
  • Disease Models, Animal
  • Graft Rejection / drug therapy
  • Graft Rejection / prevention & control*
  • Graft vs Host Disease
  • Hematopoietic Stem Cells / drug effects
  • Hematopoietic Stem Cells / radiation effects
  • Histocompatibility / drug effects*
  • Immunosuppressive Agents / therapeutic use
  • Lymphocyte Depletion
  • Mice
  • Mice, Inbred C57BL
  • Transplantation Chimera
  • Transplantation, Homologous
  • Vidarabine / analogs & derivatives*
  • Vidarabine / pharmacology
  • Whole-Body Irradiation

Substances

  • Antineoplastic Agents
  • Immunosuppressive Agents
  • Cyclophosphamide
  • Vidarabine
  • fludarabine