Haploidentical stem cell transplantation after a reduced-intensity conditioning regimen for the treatment of advanced hematologic malignancies: posttransplantation …

A Dodero, C Carniti, A Raganato… - Blood, The Journal …, 2009 - ashpublications.org
A Dodero, C Carniti, A Raganato, A Vendramin, L Farina, F Spina, C Carlo-Stella
Blood, The Journal of the American Society of Hematology, 2009ashpublications.org
Haploidentical hematopoietic stem cell transplantation provides an option for patients with
advanced hematologic malignancies lacking a compatible donor. In this prospective phase
1/2 trial, we evaluated the role of reduced-intensity conditioning (RIC) followed by early add-
backs of CD8-depleted donor lymphocyte infusions (DLIs). The RIC regimen consisted of
thiotepa, fludarabine, cyclophosphamide, and 2 Gy total body irradiation. Twenty-eight
patients with advanced lymphoproliferative diseases (n= 24) or acute myeloid leukemia (n …
Abstract
Haploidentical hematopoietic stem cell transplantation provides an option for patients with advanced hematologic malignancies lacking a compatible donor. In this prospective phase 1/2 trial, we evaluated the role of reduced-intensity conditioning (RIC) followed by early add-backs of CD8-depleted donor lymphocyte infusions (DLIs). The RIC regimen consisted of thiotepa, fludarabine, cyclophosphamide, and 2 Gy total body irradiation. Twenty-eight patients with advanced lymphoproliferative diseases (n = 24) or acute myeloid leukemia (n = 4) were enrolled. Ex vivo and in vivo T-cell depletion was carried out by CD34+ cell selection and alemtuzumab treatment. The 2-year cumulative incidence of nonrelapse mortality was 26% and the 2-year overall survival (OS) was 44%, with a better outcome for patients with chemosensitive disease (OS, 75%). Overall, 54 CD8-depleted DLIs were administered to 23 patients (82%) at 3 different dose levels without loss of engraftment or acute toxicities. Overall, 6 of 23 patients (26%) developed grade II-IV graft-versus-host disease, mainly at dose level 2. In conclusion, our RIC regimen allowed a stable engraftment with a rather low nonrelapse mortality in poor-risk patients; OS is encouraging with some long-term remissions in lymphoid malignancies. CD8-depleted DLIs are feasible and promote the immune reconstitution.
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