T Cell-Depleted Partial Matched Unrelated Donor Transplant for Advanced Myeloid Malignancy

KIR Ligand Mismatch and Outcome

Daniel Weisdorf, Sarah Cooley, Steven Devine, Todd A. Fehniger, John DiPersio, Claudio Anasetti, Edmund K. Waller, David Porter, Sherif Farag, William Drobyski, Todd Defor, Michael Haagenson, Julie Curtsinger, Jeffrey Miller

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

To evaluate the applicability of high-dose conditioning, CD34 selection, and enhanced natural killer (NK) cell alloreactivity reported as promising after haploidentical transplantation, we tested the same strategy for patients with advanced/high-risk myeloid leukemia lacking either related or well-matched unrelated donors (URD). In a prospective multicenter clinical trial using pretransplantation conditioning of thiotepa (5 mg/kg/day × 2), fludarabine (40 mg/mg/M2/day × 5), and total body radiation (800 cGy) plus thymoglobulin (2.5 mg/kg/day × 2), as well as a CD34 selected filgrastim stimulated peripheral blood graft from a partial matched URD, we treated 24 patients. The patients (median age 40 [range: 22-61]) were mismatched at 1-3 of 10 HLA loci with their donors; all were mismatched at HLA-C. Thirty-seven percent were ethnic or racial minorities. Twenty-one of 24 engrafted promptly with 1 primary graft failure and 2 early deaths. The cumulative incidence of grade II-IV acute graft-versus-host disease (aGVHD) (34%, 95% confidence interval [CI], 14-54%), chronic GVHD (20%, 95% CI, 2%-38%), and relapse (26%, 95% CI, 8%-84%) were unaffected by KIR ligand donor:recipient mismatch (n = 5) versus KIR ligand match (n = 19). Only 3 (12%) had grade III-IV GVHD. Nonrelapse occurred in 17% (95% CI, 30%-31%) by 100 days and in 35% (95% CI, 15%-55%) by 1 year. Two-year survival and leukemia-free survival were each 40% (95% CI, 21%-59%) and was similar in KIR ligand matched or mismatched patients. Infections, mostly in the first 2 months, were frequent, and were the cause of death in 5 patients (35% of deaths). T cell recovery and NK cell proliferation and functional maturation were not altered by KIR ligand match or mismatch status. For these high-risk patients, this high intensity regimen and T depleted approach yielded satisfactory outcomes, but logistical difficulties in arranging URD grafts for patients with high-risk, unstable leukemia limited accrual. Improvements in peritransplantation disease control and additional measures to augment the allogeneic graft-versus-leukemia effect are still required.

Original languageEnglish
Pages (from-to)937-943
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume18
Issue number6
DOIs
StatePublished - Jun 2012

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Unrelated Donors
Ligands
T-Lymphocytes
Transplants
Confidence Intervals
Neoplasms
Leukemia
Natural Killer Cells
HLA-C Antigens
Thiotepa
Myeloid Leukemia
Survival
Graft vs Host Disease
Multicenter Studies
Cause of Death
Transplantation
Cell Proliferation
Tissue Donors
Clinical Trials
Radiation

Keywords

  • Leukemia
  • Mismatch
  • Transplantation
  • Unrelated donor

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

T Cell-Depleted Partial Matched Unrelated Donor Transplant for Advanced Myeloid Malignancy : KIR Ligand Mismatch and Outcome. / Weisdorf, Daniel; Cooley, Sarah; Devine, Steven; Fehniger, Todd A.; DiPersio, John; Anasetti, Claudio; Waller, Edmund K.; Porter, David; Farag, Sherif; Drobyski, William; Defor, Todd; Haagenson, Michael; Curtsinger, Julie; Miller, Jeffrey.

In: Biology of Blood and Marrow Transplantation, Vol. 18, No. 6, 06.2012, p. 937-943.

Research output: Contribution to journalArticle

Weisdorf, D, Cooley, S, Devine, S, Fehniger, TA, DiPersio, J, Anasetti, C, Waller, EK, Porter, D, Farag, S, Drobyski, W, Defor, T, Haagenson, M, Curtsinger, J & Miller, J 2012, 'T Cell-Depleted Partial Matched Unrelated Donor Transplant for Advanced Myeloid Malignancy: KIR Ligand Mismatch and Outcome', Biology of Blood and Marrow Transplantation, vol. 18, no. 6, pp. 937-943. https://doi.org/10.1016/j.bbmt.2011.11.024
Weisdorf, Daniel ; Cooley, Sarah ; Devine, Steven ; Fehniger, Todd A. ; DiPersio, John ; Anasetti, Claudio ; Waller, Edmund K. ; Porter, David ; Farag, Sherif ; Drobyski, William ; Defor, Todd ; Haagenson, Michael ; Curtsinger, Julie ; Miller, Jeffrey. / T Cell-Depleted Partial Matched Unrelated Donor Transplant for Advanced Myeloid Malignancy : KIR Ligand Mismatch and Outcome. In: Biology of Blood and Marrow Transplantation. 2012 ; Vol. 18, No. 6. pp. 937-943.
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KW - Leukemia

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