Minimizing graft rejection in allogeneic T cell-depleted bone marrow transplantation

J. P. Rigden, K. Cornetta, E. F. Srour, M. Hanna, E. R. Broun, R. Hromas, J. Baute, J. Hilton, E. Cox, L. Rubin, R. Gonin, G. Tricot

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9 Scopus citations

Abstract

Between October 1991 and May 1994, 42 patients were treated with cyclophosphamide, thiotepa, and total body irradiation followed by an allogeneic transplantation of marrow depleted of T cells with soybean agglutinin and E-rosetting. Patients included in this study had acute myelogenous leukemia (13), chronic myelogenous leukemia (12), acute lymphocytic leukemia (nine), Hodgkin's disease or non-Hodgkin's lymphoma (four), multiple myeloma (three), or myelodysplastic syndrome (one). The mean age was 34 (range 8 to 51 years). Nineteen patients had a matched sibling donor and 18 received marrow from 6/6 matched unrelated donors while five received transplants from unrelated donors disparate at one DR locus (5/6 match). Time to granulocyte engraftment (AGC ≤ 500/mm3) occurred at a mean of 16.5 days for related and 11.4 days for unrelated transplant recipients, and was related to the increased use of G-CSF in the unrelated population. There was no correlation with number of mononuclear cells, T cells, or CD34-positive cells infused, the rate of engraftment or the incidence of transplant complications. Multivariate analysis determined that G-CSF administration and a diagnosis other than ALL were the only factors associated with a faster rate of engraftment. Patients receiving unrelated donor transplants, those with ALL, or those who had a low T cell number infused (≤ 8.0 x 103 cells/kg) experienced delayed hospital discharge. The regimen resulted in excellent rates of engraftment (95.2%) with only one failure to engraft and one graft rejection. The incidence of grade III-IV acute graft-versus-host disease was 0% with sibling and 26.1% with unrelated donors. There were no cases of veno-occlusive disease. Fifty percent of patients are alive with a mean follow-up of 26.4 months. We conclude that this regimen is well tolerated and results in excellent engraftment with a low incidence of severe graft-versus-host disease and few therapy-related toxicities.

Original languageEnglish (US)
Pages (from-to)913-919
Number of pages7
JournalBone Marrow Transplantation
Volume18
Issue number5
StatePublished - Nov 1 1996

Keywords

  • Engraftment
  • Graft rejection
  • T cell depletion

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Rigden, J. P., Cornetta, K., Srour, E. F., Hanna, M., Broun, E. R., Hromas, R., Baute, J., Hilton, J., Cox, E., Rubin, L., Gonin, R., & Tricot, G. (1996). Minimizing graft rejection in allogeneic T cell-depleted bone marrow transplantation. Bone Marrow Transplantation, 18(5), 913-919.