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Low T-cell chimerism is not followed by graft rejection after nonmyeloablative stem cell transplantation (NMSCT) with CD34-selected PBSC
- Source :
- Bone marrow transplantation. 32(8)
- Publication Year :
- 2003
-
Abstract
- We investigate the feasibility of CD34-selected peripheral blood stem cell (PBSC) transplantation followed by pre-emptive CD8-depleted donor lymphocyte infusions (DLI) after a minimal conditioning regimen. Six patients with advanced hematological malignancies ineligible for a conventional myeloablative transplant (n=5) or metastatic renal cell carcinoma (n=1), and with an HLA-identical (n=4) or alternative (n=2) donor were included. The nonmyeloablative conditioning regimen consisted in 2 Gy TBI alone (n=4), 2 Gy TBI and fludarabine (RCC patient, n=1) or cyclophosphamide and fludarabine (patient who had previously received 12 Gy TBI, n=1). Post transplant immunosuppression was carried out with cyclosporin (CyA) and mycophenolate mofetil (MMF). Initial engraftment was achieved in all patients. One out of six patients (17%) experienced grade > or =2 acute GVHD only after abrupt cyclosporin discontinuation and alpha interferon therapy for life-threatening tumor progression. T-cell chimerism was 23% (19-30) on day 28, 32% (10-35) on day 100, 78% (49-95) on day 180 and 99.5% (99-100) on day 365. Three out of four patients who had measurable disease before the transplant experienced a complete response. We conclude that CD34-selected NMSCT followed by CD8-depleted DLI is feasible and preserves engraftment and apparently also the graft-versus-leukemia (GVL) effect. Further studies are needed to confirm this encouraging preliminary report.
- Subjects :
- Adult
Graft Rejection
Male
medicine.medical_specialty
Transplantation Conditioning
Cyclophosphamide
medicine.medical_treatment
T-Lymphocytes
Urology
Alpha interferon
Graft vs Host Disease
Antigens, CD34
Pilot Projects
Transplantation Chimera
Hematopoietic stem cell transplantation
Cell Separation
Renal cell carcinoma
medicine
Humans
Aged
Bone Marrow Transplantation
Transplantation
business.industry
Hematopoietic Stem Cell Transplantation
Immunosuppression
Hematology
Middle Aged
medicine.disease
Surgery
Fludarabine
Feasibility Studies
business
medicine.drug
Subjects
Details
- ISSN :
- 02683369
- Volume :
- 32
- Issue :
- 8
- Database :
- OpenAIRE
- Journal :
- Bone marrow transplantation
- Accession number :
- edsair.doi.dedup.....d2d9c502711f1efabe9f8259dae060a5