αβ T Cell-Depleted Haploidentical Hematopoietic Stem Cell Transplantation without Antithymocyte Globulin in Children with Chemorefractory Acute Myelogenous Leukemia.

Publisher: Carden Jennings Publishing Country of Publication: United States NLM ID: 9600628 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1523-6536 (Electronic) Linking ISSN: 10838791 NLM ISO Abbreviation: Biol Blood Marrow Transplant Subsets: MEDLINE

Publication: Charlottesville, VA : Carden Jennings Publishing
Original Publication: Charlottesville, VA : Kluge Carden Jennings Publishing, Co., Ltd., [1995-

Receptors, Antigen, T-Cell, alpha-beta*; Hematopoietic Stem Cell Transplantation/*methods ; Leukemia, Myeloid, Acute/*therapy ; Lymphocyte Depletion/*methods ; Salvage Therapy/*methods; Child ; Graft vs Host Disease/etiology ; Hematopoietic Stem Cell Transplantation/adverse effects ; Hematopoietic Stem Cell Transplantation/mortality ; Humans ; Leukemia, Myeloid, Acute/complications ; Leukemia, Myeloid, Acute/mortality ; Lymphocyte Transfusion ; Survival Analysis ; Transplantation, Haploidentical ; Transplantation, Homologous ; Treatment Outcome

We evaluated the outcome of αβ T cell-depleted haploidentical hematopoietic stem cell transplantation (HSCT) in a cohort of children with chemorefractory acute myelogenous leukemia (AML). Twenty-two patients with either primary refractory (n = 10) or relapsed refractory (n = 12) AML in active disease status received a transplant from haploidentical donors. The preparative regimen included cytoreduction with fludarabine and cytarabine and subsequent myeloablative conditioning with treosulfan and thiotepa. Antithymocyte globulin was substituted with tocilizumab in all patients and also with abatacept in 10 patients. Grafts were peripheral blood stem cells engineered by αβ T cell and CD19 depletion. Post-transplantation prophylactic therapy included infusion of donor lymphocytes, composed of a CD45RA-depleted fraction with or without a hypomethylating agent. Complete remission was achieved in 21 patients (95%). The cumulative incidence of grade II-IV acute graft-versus-host disease (GVHD) was 18%, and the cumulative incidence of chronic GVHD was 23%. At 2 years, transplantation-related mortality was 9%, relapse rate was 42%, event-free survival was 49%, and overall survival was 53%. Our data suggest that αβ T cell-depleted haploidentical HSCT provides a reasonable chance of long-term survival in a cohort of children with chemorefractory AML and creates a solid basis for further improvement.
(Copyright © 2019 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)

Keywords: Abatacept; Chemorefractory acute myelogenous leukemia; Haploidentical; Selective αβ T cell depletion; Tocilizumab

0 (Receptors, Antigen, T-Cell, alpha-beta)

Date Created: 20190125 Date Completed: 20200320 Latest Revision: 20200320

20240829

10.1016/j.bbmt.2019.01.023

30677509