Abstract
Haematopoietic stem cell transplantation may be curative therapy for selected patients with haematological malignancies. We reviewed our experience in individuals with lymphoid neoplasms (excluding multiple myeloma) who received an allogeneic stem cell transplant from HLA identical sibling donors. Myeloablative conditioning was radiation based (n= 46) or with chemotherapy (n= 12). GvHD prophylaxis was with T-cell depletion (CAMPATH-1 g or H,“ in the bag”). 17 received a BMT while 41 had PBPC (median CD34+ 2.64). Patients receiving BMT had no further immunosuppression, while 12 patients who received PBPC grafts received prednisone 30 mg and another 21 were treated with therapeutic doses of cyclosporine for 90 days. The diagnosis was indolent lymphoma in 14 (median 3 treatment modalities), aggressive variant in 18 (7 with transformed DLBC; 6 with lymphoblastic lymphoma, 2 mantle cell), 5 had chemotherapy responsive (median 4 treatments) recurrent Hodgkin’s lymphoma and 21 had lymphoblastic leukaemia (18 in CR1). Median age was younger in patients with ALL (24 years; range 15–45) than lymphoma (47 years; 29–57; p< 0.001). At a median follow up of 1173 (32–5598) days, 20 have died and 67% survive disease free. Death was from disease recurrence in 15 (10 with ALL), and it was transplant related in 4 while one patient died of AIDS. Survival was significantly worse in patients with lymphoblastic leukaemia (48%; p< 0.001), while 76% of those with lymphomas survive in unmaintained remission (median 1493 days; 32–5598). Survival was significantly associated with diagnosis of lymphoma (p< 0.01), CD34+ cell number above median (p= 0.04) and absence of GvHD (p< 0.01). We conclude that despite T-cell depletion allogeneic stem cell transplantation is very effective therapeutic strategy in patients with lymphoma, as disease recurrence was low (relapse 6/37; p= 0.03), suggesting remaining graft vs. lymphoma effect. To the contrary, this therapy remains less satisfactory for patients with ALL who have poor prognostic factors.
Effect of alemtuzumab-based T-cell depletion on graft compositional change in vitro and immune reconstitution early after allogeneic stem cell transplantation
