Back to Search
Start Over
CD3+ cell dose and disease status are important factors determining clinical outcomes in patients undergoing unmanipulated haploidentical blood and marrow transplantation after conditioning including antithymocyte globulin.
- Source :
-
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [Biol Blood Marrow Transplant] 2007 Dec; Vol. 13 (12), pp. 1515-24. - Publication Year :
- 2007
-
Abstract
- Haploidentical transplantation is a feasible alternative for patients with life-threatening hematologic diseases who lack a matched donor. Factors affecting the clinical outcomes of haploidentical transplantation remain under investigation. We analyzed 157 consecutive patients with leukemia who underwent transplantation with nonmanipulated granulocyte colony-stimulating factor (G-CSF)-mobilized marrow and peripheral blood cells (G-BMPBs) from haploidentical donors after receiving myeloablative chemotherapy (Ara-C + BuCy + antithymocyte globulin). Follow up observations after transplantation were made from 48 days to 1191 days (median, 448 days). Multivariate analysis indicated that the cohort given higher doses of CD3(+) cells (> or = 177 x 10(6) /kg) in allograft transplantation had a significantly lower treatment-related mortality (TRM) (relative risk [RR] = 0.35; 95% CI = 0.16-0.77; P = .0090), better leukemia-free survival (LFS) (RR = 0.46; 95% CI = 0.26-0.84; P = .0106), and better overall survival (OS) (RR = 0.42; 95% CI = 0.23-0.78; P = .0058). Inversely, advanced-stage disease was a strong predictor of greater posttransplantation relapse (RR = 3.48; 95% CI = 1.26- 9.60; P = .0159), worse LFS (RR = 2.56; 95% CI = 1.33-4.95; P = .0050), and worse OS (RR = 2.77; 95% CI = 1.39-5.53; P = .0038). A high number of CD3(+) cells (> 177 x 10(6)/kg) given to patients resulted in statistically less TRM and more intensive graft versus leukemia effect without producing more severe grades of GVHD, all resulting in a significantly better overall clinical outcome from haploidentical transplantation.
- Subjects :
- Adolescent
Adult
Bone Marrow Transplantation mortality
CD3 Complex therapeutic use
Child
China epidemiology
Disease-Free Survival
Female
Follow-Up Studies
Graft vs Leukemia Effect
Haploidy
Hematopoietic Stem Cell Transplantation adverse effects
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Peripheral Blood Stem Cell Transplantation mortality
Transplantation Conditioning methods
Transplantation, Homologous adverse effects
Transplantation, Homologous mortality
Antilymphocyte Serum therapeutic use
HLA Antigens adverse effects
HLA Antigens immunology
Hematopoietic Stem Cell Transplantation mortality
Leukemia therapy
Myelodysplastic Syndromes therapy
T-Lymphocyte Subsets transplantation
Subjects
Details
- Language :
- English
- ISSN :
- 1083-8791
- Volume :
- 13
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 18022582
- Full Text :
- https://doi.org/10.1016/j.bbmt.2007.09.007