Reduced-Intensity Conditioning Combined with (188)Rhenium Radioimmunotherapy before Allogeneic Hematopoietic Stem Cell Transplantation in Elderly Patients with Acute Myeloid Leukemia: The Role of In Vivo T Cell Depletion

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

Abstract

The combination of reduced-intensity conditioning, (188)rhenium anti-CD66 radioimmunotherapy, and in vivo T cell depletion was successfully applied in elderly patients with acute myeloid leukemia or myelodysplastic syndrome. Within a prospective phase II protocol, we investigated whether a dose reduction of alemtuzumab (from 75 mg to 50 mg MabCampath) would improve leukemia-free survival by reducing the incidence of relapse. Fifty-eight patients (median age, 67 years; range, 54 to 76) received radioimmunotherapy followed by fludarabine 150 mg/m(2) and busulfan 8 mg/kg combined with either 75 mg (n = 26) or 50 mg (n = 32) alemtuzumab. Although we observed a trend towards a shorter duration of neutropenia in the 50 mg group (median, 19 versus 21 days; P = .07), the time from transplantation to neutrophil and platelet engraftment as well as the overall incidence of engraftment did not differ. The incidence of severe acute graft-versus-host disease tended to be higher after the lower alemtuzumab dose (17% versus 4%; P = .15). No significant differences in the cumulative incidences of relapse (38% versus 35%; P = .81) or nonrelapse mortality (46% versus 27%; P = .31) were observed. Accordingly, disease-free and overall survival were not significantly different between groups. Although the feasibility of radioimmunotherapy plus reduced-intensity conditioning could be demonstrated in elderly patients, the dose reduction of alemtuzumab had no positive impact on overall outcome.

Details

OriginalspracheEnglisch
Seiten (von - bis)1754-1760
Seitenumfang7
FachzeitschriftBiology of Blood and Marrow Transplantation
Jahrgang21
Ausgabenummer10
PublikationsstatusVeröffentlicht - Okt. 2015
Peer-Review-StatusJa

Externe IDs

Scopus 84941318001
researchoutputwizard legacy.publication#67246
PubMed 26001695

Schlagworte

Schlagwörter

  • Aged, Alemtuzumab, Allografts, Antibodies, Monoclonal/immunology, Antibodies, Monoclonal, Humanized/administration & dosage, Antigens, CD/immunology, Antigens, Neoplasm/immunology, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Busulfan/administration & dosage, Cell Adhesion Molecules/immunology, Combined Modality Therapy, Disease-Free Survival, Dose-Response Relationship, Drug, Feasibility Studies, Female, Graft vs Host Disease/epidemiology, Graft vs Leukemia Effect, Humans, Immunoconjugates/therapeutic use, Leukemia, Myeloid, Acute/drug therapy, Lymphocyte Depletion/adverse effects, Male, Middle Aged, Myelodysplastic Syndromes/drug therapy, Neutropenia/etiology, Prospective Studies, Radioimmunotherapy, Radioisotopes/therapeutic use, Rhenium/therapeutic use, T-Lymphocytes/immunology, Transplantation Conditioning/adverse effects, Vidarabine/administration & dosage