Post-transplant T cell chimerism predicts graft versus host disease but not disease relapse in patients undergoing an alemtuzumab based reduced intensity conditioned allogeneic transplant

Leuk Res. 2013 May;37(5):561-5. doi: 10.1016/j.leukres.2013.01.010. Epub 2013 Feb 5.

Abstract

In this multicentre retrospective study we have studied the impact of T cell chimerism on the outcome of 133 patients undergoing an alemtuzumab based reduced intensity conditioning allograft (RIC). The median age of the patients was 50 years (range 42-55 years). 77 patients were transplanted using an HLA identical sibling donor while 56 patients received a fully matched volunteer unrelated donor graft. 64 patients had a lymphoid malignancy and 69 were transplanted for a myeloid malignancy. 38 patients (29%) relapsed with no significant difference in risk of relapse between patients developing full donor and mixed donor chimerism in the T-cell compartment on D+90 and D+180 post transplant. Day 90 full donor T cell chimerism correlated with an increased incidence of acute GVHD according to NIH criteria (p=0.0004) and the subsequent development of chronic GVHD. Consistent with previous observations, our results confirmed a correlation between the establishment of T cell full donor chimerism and acute GVHD in T deplete RIC allografts. However our study failed to identify any correlation between T cell chimerism and relapse risk and challenge the use of pre-emptive donor lymphocyte infusions (DLI) in patients with mixed T cell chimerism transplanted using an alemtuzumab based RIC regimen.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Adult
  • Alemtuzumab
  • Antibodies, Monoclonal, Humanized / administration & dosage*
  • Antineoplastic Agents / administration & dosage*
  • Chronic Disease
  • Graft vs Host Disease / etiology*
  • Graft vs Host Disease / therapy
  • Hematologic Neoplasms / therapy*
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Siblings
  • Stem Cell Transplantation*
  • T-Lymphocytes*
  • Transplantation Chimera*
  • Transplantation Conditioning*
  • Transplantation, Homologous

Substances

  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents
  • Alemtuzumab