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T cell-depleted nonmyeloablative stem cell transplantation: what is the optimum balance between the intensity of host conditioning and the degree of T cell depletion of the graft?

Bone Marrow Transplantation volume 28, pages 313–314 (2001)Cite this article

The use of non-myelabalative allogeneic stem cell transplantation is gaining widespread acceptance as this can be offered to patients considered ineligible for a conventional conditioning. However graft-versus-host disease (GVHD) continues to be a major concern after such transplants.1,2 Conditioning with fludarabine and melphalan was recently reported to be associated with a high incidence of grade 2–4 GVHD.2 We have previously reported successful engraftment and a low incidence of GVHD with the addition of Campath-1H in vivo to this protocol.3 However, this regimen was associated with a very high incidence of viral reactivation and delayed immune reconstitution.4 The recent report from Craddock et al5 on the successful engraftment and low incidence of GVHD following the use of CD34-selected grafts is also encouraging.

At our centre, T cell depletion with Campath-1H ‘in the bag’ for PBSC grafts from both related (n = 17) and unrelated donors (n = 3) conditioned with high-dose chemo-radiotherapy was associated with durable engraftment (19/20), low incidence of acute GVHD (grade 1–2; 5/20) and transplant-related mortality (3/20). Similar results were reported by Hale et al6 with the use of Campath-1G as well as 1-H ‘in the bag’.

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References

  1. Slavin S, Nagler A, Naparstek E et al. Nonmyeloablative stem cell transplantation and cell therapy as an alternative toconventional bone marrow transplantation with lethal cytoreduction for the treatment of malignant and nonmalignant hematologic diseases Blood 1998 91: 756–763

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Authors and Affiliations

  1. Department of Haematology, Birmingham Heartlands Hospital, Birmingham, B9 5SS, UK

    S Chakrabarti & DW Milligan

  2. Stem Cell Group, Blood Transfusion Services, Birmingham, UK

    D McDonald

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  1. S Chakrabarti
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  2. D McDonald
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  3. DW Milligan
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Chakrabarti, S., McDonald, D. & Milligan, D. T cell-depleted nonmyeloablative stem cell transplantation: what is the optimum balance between the intensity of host conditioning and the degree of T cell depletion of the graft?. Bone Marrow Transplant 28, 313–314 (2001). https://doi.org/10.1038/sj.bmt.1703117

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