Unrelated donor peripheral blood stem cell transplants incorporating pre-transplant in-vivo Alemtuzumab are not associated with any increased risk of significant acute or chronic GVHD

Bronwen E Shaw (1) , Jane Apperley (2) , Nigel H Russell (3) , Charles Craddock (4) , Effie Liakopoulou (5) , M Potter (6) , Robert F Wynn (7) , Brenda Gibson (8) , Rachel M Pearce (9) , Keiren Kirkland (10) , Julia Lee (11) , Alejandro Madrigal (12) , Gordon Cook (13) , Jennifer L Byrne (14)

1 Haemato-Oncology
2 Department of Haematology
3 Haematology
4 Department of Haematology
5 Haematology and Transplantation
6 haematology
7 Department of Haematology
8 Dept of Haematology
9 BSBMT
10 HEAD OF DATA REGISTRY
11 BSBMT Data Registry
12 Royal Free Hospital [London, UK]
13 Haematology
14 Department of Haematology

There is little information published on the long-term outcomes in recipients of T-cell depleted (TCD) unrelated donor (UD) transplants comparing Peripheral Blood Stem Cells (PBSC) with Bone Marrow (BM). We present retrospective outcome data on 306 recipients of myeloablative, HLA-matched UD allografts using pre-transplant in-vivo Alemtuzumab. Transplants were performed between 2000-2007 for CML (CP1) and acute leukaemia (CR1/2) and 184 patients received BM and 122 PBSC. The median age was 28.9 years (<1-58years) and the median follow-up was 48 months. Overall survival at 8 years is 53%. The incidence of acute GvHD was significantly higher in PBSC (65%) than BM recipients (49%; p=0.012). This represented only grade 1 GVHD with no difference in grade II-IV aGvHD (BM 23% PBSC 24%). The incidence of chronic GvHD, either overall (BM 47%, PBSC 49%) or extensive (BM 15%, PBSC 13%) was not increased with PBSC. The incidence of relapse, non-relapse mortality and survival were not significantly different. Whilst accepting the limitations of retrospective analyses, we suggest the increased risk of GvHD in recipients of PBSC in T-replete transplants is offset by in-vivo Alemtuzumab, and that either stem cell source can be used with good outcomes in this setting.

Mots clés: Medicine

Bronwen E Shaw, Jane Apperley, Nigel H Russell, Charles Craddock, Effie Liakopoulou, et al.. Unrelated donor peripheral blood stem cell transplants incorporating pre-transplant in-vivo Alemtuzumab are not associated with any increased risk of significant acute or chronic GVHD. British Journal of Haematology, 2011, 153 (2), pp.244. ⟨10.1111/j.1365-2141.2011.08615.x⟩. ⟨hal-00620598⟩