The impact of T-cell depletion techniques on the outcome after haploidentical hematopoietic SCT

Bone Marrow Transplant. 2014 Jan;49(1):55-61. doi: 10.1038/bmt.2013.132. Epub 2013 Sep 16.

Abstract

Several T-cell depletion (TCD) techniques are used for haploidentical hematopoietic SCT (HSCT), but direct comparisons are rare. We therefore studied the effect of in vitro TCD with graft engineering (CD34 selection or CD3/CD19 depletion, 74%) or in vivo TCD using alemtuzumab (26%) on outcome, immune reconstitution and infections after haploidentical HSCT. We performed a retrospective multicenter analysis of 72 haploidentical HSCT in Switzerland. Sixty-seven patients (93%) had neutrophil engraftment. The 1-year OS, TRM and relapse incidence were 48 (36-60)%, 20 (11-33)% and 42 (31-57)%, respectively, without differences among the TCD groups. In vivo TCD caused more profound lymphocyte suppression early after HSCT, whereas immune recovery beyond the second month was comparable between the two groups. Despite anti-infective prophylaxis, most patients experienced post-transplant infectious complications (94%). Patients with in vivo TCD had a higher incidence of CMV reactivations (54% vs 28%, P=0.015), but this did not result in a higher TRM. In conclusion, TCD by graft engineering or alemtuzumab are equally effective for haploidentical HSCT.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adsorption
  • Adult
  • Alemtuzumab
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antigens, CD19 / metabolism
  • Antigens, CD34 / metabolism
  • Antineoplastic Agents / therapeutic use
  • CD3 Complex / metabolism
  • Child
  • Child, Preschool
  • Female
  • Graft vs Host Disease
  • Hematologic Neoplasms / therapy*
  • Hematopoietic Stem Cell Mobilization
  • Hematopoietic Stem Cell Transplantation / methods*
  • Humans
  • Infant
  • Infant, Newborn
  • Lymphocyte Depletion / methods*
  • Male
  • Middle Aged
  • Neutrophils / cytology
  • Recurrence
  • Retrospective Studies
  • Switzerland
  • T-Lymphocytes / immunology*
  • Transplantation Conditioning
  • Treatment Outcome
  • Young Adult

Substances

  • Antibodies, Monoclonal, Humanized
  • Antigens, CD19
  • Antigens, CD34
  • Antineoplastic Agents
  • CD3 Complex
  • Alemtuzumab