In Vivo T Cell Depletion with Myeloablative Regimens on Outcomes after Cord Blood Transplantation for Acute Lymphoblastic Leukemia in Children.

Abstract

The inclusion of antithymocyte globulin (ATG) in cord blood transplantation is controversial. We evaluated outcomes according to ATG inclusion in 297 children and adolescents with acute lymphoblastic leukemia (ALL) who received myeloablative total body irradiation-based conditioning and either single-unit (74%) or double-unit (26%) grafts. Ninety-two patients (31%) received ATG and 205 (69%) did not. ATG recipients were more likely to be cytomegalovirus seronegative. The incidences of day 100 grades II to IV acute graft-versus-host disease (GVHD; 30% versus 54%, P = .0002) and chronic GVHD (22% versus 43%, P = .0008) were lower with ATG compared with non-ATG regimens. However, day 100 grades III to IV acute GVHD was comparable (11% versus 17%, P = .15). The 3-year incidences of transplant-related mortality (16% versus 17%, P = .98), relapse (17% versus 27%, P = .12), and leukemia-free survival (66% versus 55%, P = .23) in ATG and non-ATG recipients were similar. There were no differences in viral reactivation between treatment groups (60% versus 58%, P = .83). Therefore, the data suggest that incorporation of ATG with myeloablative conditioning regimens may be useful in reducing the risk of acute and chronic GVHD without any deleterious effect on transplant-related mortality, relapse, or leukemia-free survival in children and adolescents with ALL.

• Authors: Doris M Ponce, Mary Eapen, Rodney Sparapani, Tracey A O'Brien, Ka Wah Chan, Junfang Chen, John Craddock, Kirk R Schultz, John E Wagner, Miguel-Angel Perales, Juliet N Barker
• Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 21 Issue 12 Pg. 2173-2179 (Dec 2015) ISSN: 1523-6536 [Electronic] United States
• PMID: 26327630 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
• Copyright: Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antilymphocyte Serum
• Immunosuppressive Agents
• Myeloablative Agonists

Topics

• Acute Disease
• Adolescent
• Antilymphocyte Serum (therapeutic use)
• Child
• Child, Preschool
• Cord Blood Stem Cell Transplantation (methods)
• Female
• Graft Survival
• Graft vs Host Disease (immunology, mortality, pathology, prevention & control)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Infant
• Lymphocyte Depletion
• Male
• Myeloablative Agonists (therapeutic use)
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (immunology, mortality, pathology, therapy)
• Recurrence
• Remission Induction
• Retrospective Studies
• Survival Analysis
• Transplantation Conditioning (methods)
• Transplantation, Homologous
• Treatment Outcome
• Whole-Body Irradiation
• Young Adult