Haploidentical transplants using partial T-cell depletion, cyclosporin and low-dose antithymocyte globulin as gvhd prophylaxis

James A. Russell, Ahsan M. Chaudhry, Peter Duggan, Douglas Stewart, Dean Ruether, Stefan Gluck, Don Morris, Max J. Coppes, Ron Anderson, Johannes Wolff, Maarten Egeler, Karen Booth, Sunil Desai, Loree Larratt, Robert Turner, Christopher B. Brown

Research output: Contribution to journalArticle

Abstract

We have studied the feasibility of performing haploidentical stem cell transplants in 26 patients aged 1-54 (median 32) using CD34+ cell selection by the Cellpro device which gives approximately 2 logs of T-cell depletion. All patients (pts) received additional acute GVHD prophylaxis with cyclosporin A plus antithymocyte globulin (ATG, Thymoglobulin) 4.5mg/kg (6mg/kg if <30kg) over 3 days pretransplant. The cytoreductive regimens largely included cyclophosphamide 180mg/kg with either thiotepa 15mg/kg and 500cGy TBI (6 pts) or fludarabine 250mg/m5 and TBI 1200cGy (12 pts) with other combinations in the remaining 8. Donors were mismatched by 2 or more A, B and DR antigens. All patients had high-risk disease, 15 AML +/- MDS, 3 ALL, 2 NHL, 2 CML, 2 malignant histiocytosis and one CLL. Median dose of CD 34+ cells was 3.8 x 10"/kg (range 0.4 - 25), of CD3+ cells 8 x 105/kg (range 1 - 220). Of 23 evaluable patients, 5 failed to engraft granulocytes, 2 with persistent disease, 3 attributable to primary graft failure. Six additional pts evaluable for platelet engraftment failed to recover platelets, 2 with viral infection, one multiorgan failure, one persistent disease, one GVHD and one HUS. Of 21 evaluable pts 2 developed grade II and 2 grade III GVHD and 4 patients experienced chronic GVHD. Opportunistic infection contributed to death in 10 patients. There was one fatal case of PTLD in a pt with chronic GVHD. Three pts survive at 39, 40 and 58 months. Actuarial 3 year DPS for leukemic pts <35 years old is 30%. Haploidentical transplants are feasible, at least in younger pts, with partial T-depletion and additional immunosuppresion. This regimen results in no more acute GVHD than unmanipulated transplants from matched donors. Immune reconstitution remains a major challenge but early PTLD was not observed.

Original languageEnglish (US)
Pages (from-to)364b
JournalBlood
Volume96
Issue number11 PART II
StatePublished - Dec 1 2000

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Fingerprint Dive into the research topics of 'Haploidentical transplants using partial T-cell depletion, cyclosporin and low-dose antithymocyte globulin as gvhd prophylaxis'. Together they form a unique fingerprint.

  • Cite this

    Russell, J. A., Chaudhry, A. M., Duggan, P., Stewart, D., Ruether, D., Gluck, S., Morris, D., Coppes, M. J., Anderson, R., Wolff, J., Egeler, M., Booth, K., Desai, S., Larratt, L., Turner, R., & Brown, C. B. (2000). Haploidentical transplants using partial T-cell depletion, cyclosporin and low-dose antithymocyte globulin as gvhd prophylaxis. Blood, 96(11 PART II), 364b.