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Graft-Versus-Host Disease

Low-dose alemtuzumab for GvHD prevention followed by prophylactic donor lymphocyte infusions in high-risk leukemia

Bone Marrow Transplantation volume 52, pages 445–451 (2017)Cite this article

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Abstract

We analyzed the use of low-dose alemtuzumab in a cohort of 158 consecutive patients who underwent allogeneic PBSC transplantation. Patients with high-risk acute leukemia were prospectively screened for prophylactic donor lymphocyte infusion (pDLI). Lymphocytes were administered repeatedly at low and non-escalating doses (0.5–1 × 106/kg). Low-dose alemtuzumab was effective in prevention of acute GvHD after sibling or well-matched unrelated transplantation, whereas a more intensified approach was needed after mismatched transplantation. The cumulative incidence of chronic moderate/severe chronic-GvHD (cGvHD) was 15.6%. In total, 63 high-risk leukemia patients were eligible for pDLI. Only 1 out of the 39 pDLI recipients relapsed as compared with 7 out of the 24 recipients, who did not receive pDLI due to logistical hurdles. In multivariate analysis, the use of adjuvant lymphocyte therapy was significantly associated with reduced incidence of relapse and improved disease-free survival. In summary, low-dose alemtuzumab confers to a low cGvHD incidence and the administration of pDLIs in this context is very likely to reduce relapse risk in high risk leukemia patients. This is translated in an estimated 5-year probability of GvHD-free and relapse-free survival of 43.3% for the 136 leukemia patients.

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Acknowledgements

We acknowledge the nurses, physicians, technicians and data managers for their dedication to the patients. We specially thank our colleagues in hospitals in Greece and Cyprous for patient referral and fruitful collaboration in patient care.

Author contributions

All authors were immediately involved in patient’s care. ML and KG provided patient data for analysis. PT and AS analyzed data and wrote the manuscript.

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Author notes

  1. P Tsirigotis and A Spyridonidis: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, BMT Unit, ‘Attikon’ University Hospital of Athens, Athens, Greece

    P Tsirigotis, K Gkirkas, M Stamouli & I Pessach

  2. Department of Internal Medicine, BMT Unit, University Hospital of Patras, Rio, Greece

    M Liga, E Triantafyllou, M Marangos, A Sarantopoulos, N Spyridis & A Spyridonidis

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  1. P Tsirigotis
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Correspondence to A Spyridonidis.

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Tsirigotis, P., Liga, M., Gkirkas, K. et al. Low-dose alemtuzumab for GvHD prevention followed by prophylactic donor lymphocyte infusions in high-risk leukemia. Bone Marrow Transplant 52, 445–451 (2017). https://doi.org/10.1038/bmt.2016.272

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