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Transplant Outcomes

Impact of in vivo T-cell depletion on outcome of AML patients in first CR given peripheral blood stem cells and reduced-intensity conditioning allo-SCT from a HLA-identical sibling donor: a report from the Acute Leukemia Working Party of the European group for Blood and Marrow Transplantation

Abstract

The impact of in vivo T-cell depletion on transplantation outcomes in patients transplanted with reduced-intensity conditioning (RIC) remains controversial. This study assessed the outcome of 1250 adult patients with de novo AML in first CR (CR1) given PBSC from HLA-identical siblings after chemotherapy-based RIC. A total of 554 patients did not receive any form of in vivo T-cell depletion (control group), whereas antithymocyte globulin (ATG) and alemtuzumab were given in 444 and 252 patients, respectively. The incidences of grade II-IV acute GVHD were 21.4, 17.6 and 10.2% in control, ATG and alemtuzumab patients, respectively (P<0.001). In multivariate analysis, the use of ATG and the use of alemtuzumab were each associated with a lower risk of chronic GVHD (P<0.001 each), but a similar risk of relapse, and of nonrelapse mortality, and similar leukemia-free survival and OS. Further, among patients given BU-based RIC, the use of <6 mg/kg ATG did not increase the risk of relapse (hazard ratio, HR=1.1), whereas there was a suggestion for higher relapse risk in patients given 6 mg/kg ATG (HR=1.4, P=0.08). In summary, these data suggest that a certain amount of in vivo T-cell depletion can be safely used in the conditioning of AML patients in CR1 given PBSC after chemotherapy-based RIC.

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Correspondence to F Baron.

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Competing interests

MM has received lectures honoraria and research support from Genzyme and Fresenius whose products are discussed in this manuscript. FB has received lectures honoraria and research support from Genzyme. DB has received honoraria and research funding from Genzyme/Sanofi. AN has received research grants from Fresenius and Genzyme, took part in some of their clinical trials (Fresenius and Genzyme), participate in their investigator meeting and advisory board (Genzyme) and lecture for them (satellite meeting and special meeting+honorarium). RFD received lectures honoraria and research support from Genzyme and Sanofi.

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The study has been presented in part as an oral abstract at the 2013 meeting if the European group for Blood and Marrow Transplantation, London April 7-10.

Author contributions

FB wrote the manuscript, designed the study and interpreted the data; ML designed the study, analyzed the data, interpreted the data and edited the manuscript; MM designed the study, interpreted the data and edited the manuscript; DB, LL-C, SV, CC, MA, PJ, HG, GS, PC, PB, AS, RFD, AN participated in study collection or design, provided clinical data and critically reviewed and gave final approval of the manuscript.

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Baron, F., Labopin, M., Blaise, D. et al. Impact of in vivo T-cell depletion on outcome of AML patients in first CR given peripheral blood stem cells and reduced-intensity conditioning allo-SCT from a HLA-identical sibling donor: a report from the Acute Leukemia Working Party of the European group for Blood and Marrow Transplantation. Bone Marrow Transplant 49, 389–396 (2014). https://doi.org/10.1038/bmt.2013.204

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