1. ¹Department of Haematology, John Radcliffe Hospital, Oxford, UK
2. ²BSBMT Data Registry, Guy's Hospital, London, UK
3. ³Department of Haematology, Manchester Royal Infirmary, Manchester, UK
4. ⁴Department of Haematology, St Bartholomew's Hospital, London, UK
5. ⁵Haematology, Queen Elizabeth Hospital, Birmingham, UK
6. ⁶Department of Haematology, Southampton General Hospital, Southampton, UK
7. ⁷Hammersmith Hospital, London, UK
8. ⁸Glasgow Royal Infirmary, Glasgow, UK
9. ⁹Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
10. ¹⁰Bone Marrow Transplant Unit, Bristol Children's Hospital, Bristol, UK

Correspondence: Dr RK Malladi, Department of Haematology, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK. E-mail: ram.malladi@ndcls.ox.ac.uk

Received 25 January 2008; Revised 1 July 2008; Accepted 23 July 2008; Published online 24 November 2008.

Abstract

By retrospective analysis of 88 patients from the British Society of Blood and Marrow Transplantation registry, we investigated the effect of in vivo T-cell depletion in HLA-identical sibling reduced-intensity conditioning (RIC) allografts for adult AML by comparing patients who received alemtuzumab with those without alemtuzumab conditioning. Both groups were equivalent for age, sex, karyotype and disease status at transplant. With a median follow-up of 27 months (3–72 months) and 48 months (7–72 months), the 2- and 5-year overall survival, with or without alemtuzumab, is 60 and 60% (P=0.80) and 61 and 53%, respectively (P=0.85). The 2-year non-relapse mortality is 12% with alemtuzumab, and 17% without alemtuzumab (P=0.49). The 2-year relapse rate is 35% with alemtuzumab compared with 19% without alemtuzumab (P=0.28). Grades II–IV acute GVHD occurred in 22% (8/37) without alemtuzumab compared with 14% (7/51) given alemtuzumab (P=0.25). Extensive chronic GVHD occurred in 47% (14/30) not given alemtuzumab compared with 4% (2/45) who were given alemtuzumab (P=0.001). Among evaluable patients, the risk of infections was higher in those treated with alemtuzumab compared with those not treated with alemtuzumab (79 vs 57%, respectively, P=0.02). In conclusion, alemtuzumab has a beneficial effect by reducing chronic GVHD without affecting overall survival. Further studies are warranted before alemtuzumab can be recommended as standard in RIC allografts for AML.