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Alemtuzumab markedly reduces chronic GVHD without affecting overall survival in reduced-intensity conditioning sibling allo-SCT for adults with AML

Alemtuzumab markedly reduces chronic GVHD without affecting overall survival in reduced-intensity conditioning sibling allo-SCT for adults with AML
Alemtuzumab markedly reduces chronic GVHD without affecting overall survival in reduced-intensity conditioning sibling allo-SCT for adults with AML
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.
alemtuzumab, AML, allograft, GVHD
0268-3369
709-715
Malladi, R.K.
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Peniket, A.J.
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Littlewood, T.J.
598e530e-0e9d-46b8-b744-b99e450e80e1
Towlson, K.E.
2c1131c6-a5a2-4458-9708-c5f407973e6b
Pearce, R.
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Yin, J.
b671f355-d930-437c-a414-e8dbc2c55f74
Cavenagh, J.D.
c0f299de-2041-470a-87ee-6443b529e6d1
Craddock, C.
10587977-6515-440b-92fb-0b5dd2190bfe
Orchard, K.H.
794654ab-d6cc-488a-ac11-c9217433c7a2
Olavarria, E.
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McQuaker, G.
d8732d10-e668-432a-a815-01544cf0c13f
Collin, M.
8c041c52-7ce4-4cdc-8552-8bde68169de6
Marks, D.I.
633e0b1d-bcdc-421d-86d2-8fd5ebb27911
Malladi, R.K.
4f8040f3-6b00-46c7-869f-89074d7c6cbf
Peniket, A.J.
f577b045-ee3e-4a13-a6c4-25df37ec10f9
Littlewood, T.J.
598e530e-0e9d-46b8-b744-b99e450e80e1
Towlson, K.E.
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Pearce, R.
7e1130ae-22e7-41a7-9fa1-93b3f6ca4a2c
Yin, J.
b671f355-d930-437c-a414-e8dbc2c55f74
Cavenagh, J.D.
c0f299de-2041-470a-87ee-6443b529e6d1
Craddock, C.
10587977-6515-440b-92fb-0b5dd2190bfe
Orchard, K.H.
794654ab-d6cc-488a-ac11-c9217433c7a2
Olavarria, E.
7009b036-d0e0-46ba-960e-564fe5f5e7d7
McQuaker, G.
d8732d10-e668-432a-a815-01544cf0c13f
Collin, M.
8c041c52-7ce4-4cdc-8552-8bde68169de6
Marks, D.I.
633e0b1d-bcdc-421d-86d2-8fd5ebb27911

Malladi, R.K., Peniket, A.J., Littlewood, T.J., Towlson, K.E., Pearce, R., Yin, J., Cavenagh, J.D., Craddock, C., Orchard, K.H., Olavarria, E., McQuaker, G., Collin, M. and Marks, D.I. (2009) Alemtuzumab markedly reduces chronic GVHD without affecting overall survival in reduced-intensity conditioning sibling allo-SCT for adults with AML. Bone Marrow Transplantation, 43 (9), 709-715. (doi:10.1038/bmt.2008.375).

Record type: Article

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.

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More information

Published date: May 2009
Keywords: alemtuzumab, AML, allograft, GVHD

Identifiers

Local EPrints ID: 152921
URI: http://eprints.soton.ac.uk/id/eprint/152921
ISSN: 0268-3369
PURE UUID: 9a85a875-2537-4636-b42f-8c9fd6d07c68
ORCID for K.H. Orchard: ORCID iD orcid.org/0000-0003-2276-3925

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Date deposited: 17 May 2010 15:14
Last modified: 14 Mar 2024 02:47

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Contributors

Author: R.K. Malladi
Author: A.J. Peniket
Author: T.J. Littlewood
Author: K.E. Towlson
Author: R. Pearce
Author: J. Yin
Author: J.D. Cavenagh
Author: C. Craddock
Author: K.H. Orchard ORCID iD
Author: E. Olavarria
Author: G. McQuaker
Author: M. Collin
Author: D.I. Marks

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