Ex vivo and in vivo T cell-depleted allogeneic stem cell transplantation in patients with acute myeloid leukemia in first complete remission resulted in similar overall survival: on behalf of the ALWP of the EBMT and the MSKCC |
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| Authors: | Florent Malard Myriam Labopin Christina Cho Didier Blaise Esperanza B Papadopoulos Jakob Passweg Richard O’Reilly Edouard Forcade Molly Maloy Liisa Volin Hugo Castro-Malaspina Yosr Hicheri Ann A Jakubowski Corentin Orvain Sergio Giralt Mohamad Mohty Arnon Nagler Miguel-Angel Perales |
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| Institution: | 1.Service d’Hématologie Clinique et Thérapie Cellulaire,AP-HP, H?pital Saint-Antoine,Paris,France;2.INSERM, Centre de Recherche Saint-Antoine (CRSA),Sorbonne Université,Paris,France;3.Adult Bone Marrow Transplantation Service,Memorial Sloan Kettering Cancer Center,New York,USA;4.Department of Medicine,Weill Cornell Medical College,New York,USA;5.Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille,Institut Paoli Calmettes,Marseille,France;6.University Hospital, Hematology,Basel,Switzerland;7.Bone Marrow Transplant Service, Department of Pediatrics,Memorial Sloan Kettering Cancer Center,New York,USA;8.Department of Pediatrics,Weill Cornell Medical College,New York,USA;9.CHU Bordeaux, H?pital Haut-leveque,Pessac,France;10.Stem Cell Transplantation Unit,HUCH Comprehensive Cancer Center,Helsinki,Finland;11.Département d’Hématologie Clinique,CHU Lapeyronie,Montpellier,France;12.Service des Maladies du Sang,CHRU,Angers,France;13.EBMT Paris Study Office/CEREST-TC,Paris,France;14.Hematology Division,Chaim Sheba Medical Center,Tel-Hashomer,Israel;15.Adult Bone Marrow Transplantation Service, Department of Medicine,Memorial Sloan Kettering Cancer Center,New York,USA |
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| Abstract: | BackgroundGraft-versus-host disease (GVHD) is one of the leading causes of non-relapse mortality and morbidity after allogeneic hematopoietic stem cell transplantation (allo-HCT).MethodsWe evaluated the outcomes of two well-established strategies used for GVHD prevention: in vivo T cell depletion using antithymocyte globulin (ATG) and ex vivo T cell depletion using a CD34-selected (CD34+) graft. A total of 525 adult patients (363 ATG, 162 CD34+) with intermediate or high-risk cytogenetics acute myeloid leukemia (AML) in first complete remission (CR1) were included. Patients underwent myeloablative allo-HCT using matched related or unrelated donors.ResultsTwo-year overall survival estimate was 69.9% (95% CI, 58.5–69.4) in the ATG group and 67.6% (95% CI, 60.3–74.9) in the CD34+ group (p?=?0.31). The cumulative incidence of grade II–IV acute GVHD and chronic GVHD was higher in the ATG cohort HR 2.0 (95% CI 1.1–3.7), p?=?0.02; HR 15.1 (95% CI 5.3–42.2), p?<?0.0001]. Parameters associated with a lower GVHD-free relapse-free survival (GRFS) were ATG HR 1.6 (95% CI 1.1–2.2), p?=?0.006], adverse cytogenetic HR 1.7 (95% CI 1.3–2.2), p?=?0.0004], and the use of an unrelated donor HR 1.4 (95% CI 1.0–1.9), p?=?0.02]. There were no statistical differences between ATG and CD34+ in terms of relapse HR 1.52 (95% CI 0.96–2.42), p?=?0.07], non-relapse mortality HR 0.96 (95% CI 0.54–1.74), p?=?0.90], overall survival HR 1.43 (95% CI 0.97–2.11), p?=?0.07], and leukemia-free survival HR 1.25 (95% CI 0.88–1.78), p?=?0.21]. Significantly, more deaths related to infection occurred in the CD34+ group (16/52 vs. 19/112, p?=?0.04).ConclusionsThese data suggest that both ex vivo CD34-selected and in vivo ATG T cell depletion are associated with a rather high OS and should be compared in a prospective randomized trial. |
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