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Impact of in vivo T cell depletion in HLA-identical allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission conditioned with a fludarabine iv-busulfan myeloablative regimen: a report from the EBMT Acute Leukemia Working Party

Impact of in vivo T cell depletion in HLA-identical allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission conditioned with a fludarabine iv-busulfan myeloablative regimen: a report from the EBMT Acute Leukemia Working Party

Fecha de publicación: 24/01/2017

Autores de IIS La Fe

Miguel Ángel Sanz Alonso

Autor

Participantes ajenos a IIS La Fe

Rubio, MT
D'Aveni-Piney, M
Labopin, M
Hamladji, RM
Blaise, D
Ozdogu, H
Daguindeau, E
Richard, C
Santarone, S
Irrera, G
Yakoub-Agha, I
Yeshurun, M
Diez-Martin, JL
Mohty, M
Savani, BN
Nagler, A

Grupos

Hematología y Hemoterapia

Investigador Principal

Javier De La Rubia Comos

Abstract

Background: The impact of the use of anti-thymocyte globulin (ATG) in allogeneic stem cell transplantation performed with HLA-identical sibling donors following fludarabine and 4 days intravenous busulfan myeloablative conditioning regimen has been poorly explored. Methods: We retrospectively analyzed 566 patients who underwent a first HLA-identical allogeneic stem cell transplantation with this conditioning regimen for acute myeloid leukemia in first complete remission between 2006 and 2013 and compared the outcomes of 145 (25.6%) patients who received ATG (ATG group) to 421 (74.4%) who did not (no-ATG group). The Kaplan-Meier estimator, the cumulative incidence function, and Cox proportional hazards regression models were used where appropriate. Results: Patients in the ATG group were older, received more frequently peripheral blood stem cell grafts from older donors, and were transplanted more recently. With a median follow-up of 19 months, patients in the ATG group had reduced 2-year cumulative incidence of chronic graft-versus-host disease (GVHD) (31 vs. 52%, p = 0.0002) and of its extensive form (8 vs. 26%, p < 0.0001) but similar relapse incidence (22 vs. 27%, p = 0.23) leading to improved GVHD and relapse-free survival (GRFS) (60 vs. 40%, p = 0.0001). In multivariate analyses, the addition of ATG was independently associated with lower chronic GVHD (HR = 0.46, p = 0.0001), improved leukemia-free survival (HR = 0.67, p = 0.027), overall survival (HR = 0.65, p = 0.027), and GRFS (HR = 0.51, p=4 x 10(-5)). Recipient age above 50 years was the only other factor associated with worse survivals. Conclusions: These results suggest that the use of ATG with fludarabine and 4 days intravenous busulfan followed by HLA-identical sibling donor allogeneic stem cell transplantation for acute myeloid leukemia improves overall transplant outcomes due to reduced incidence of chronic GVHD without increased relapse risk.

Datos de la publicación

ISSN/ISSNe:: 1756-8722, 1756-8722
Tipo:: Article
Páginas:: 31-31
DOI:: 10.1186/s13045-016-0389-4
Factor de Impacto:: 2,292 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Métricas

Filiaciones

Rubio, MT:: Service d'Hématologie et de Médecine interne, Hôpital Brabois, CHRU Nancy, Nancy, France.

IMoPA, CNRS UMR 7365, Nancy, France.

Université de Lorraine, Nancy, France.

CHRU Nancy, Hop Brabois, Serv Hematol & Med Interne, Nancy, France

CNRS, UMR 7365, IMoPA, Nancy, France

Univ Lorraine, Nancy, France
D'Aveni-Piney, M:: CHRU Nancy, Hop Brabois, Serv Hematol & Med Interne, Nancy, France

CNRS, UMR 7365, IMoPA, Nancy, France

Univ Lorraine, Nancy, France
Labopin, M:: ALWP Office, Hôpital Saint Antoine, Paris, France

Service d'Hématologie et de Thérapie Cellulaire, Hôpital Saint Antoine, Paris, France

INSERM UMR 938, Paris, France

Universite Pierre et Marie Curie, Paris, France

Hop St Antoine, ALWP Off, Paris, France

Hop St Antoine, Serv Hematol & Therapie Cellulaire, Paris, France

INSERM, UMR 938, Paris, France

Univ Paris 06, Paris, France
Hamladji, RM:: Service Hématologie Greffe de Moëlle, Centre Pierre et Marie Curie, Alger, Algeria

Ctr Pierre & Marie Curie, Serv Hematol Greffe Moelle, Algiers, Algeria
Sanz, MA:: Servicio de Hematología, Hospital Universitario La Fe, Valencia, Spain

Hosp Univ La Fe, Serv Hematol, Valencia, Spain
Blaise, D:: Programme de Transplantation and Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France

Inst Paoli Calmettes, Ctr Rech Cancerol Marseille, Programme Transplantat & Therapie Cellulaire, Marseille, France
Ozdogu, H:: Hematology Division, BMT Unit, Hematology Reserach Laboratory, Training and Medical, Baskent University Hospital, Adana, Turkey

Baskent Univ Hosp, Div Hematol, BMT Unit, Hematol Reserach Lab,Training & Med, Adana, Turkey
Daguindeau, E:: Hopital Jean Minjoz, Service d`Hématologie, Besancon, France

Hop Jean Minjoz, Serv Hematol, Besancon, France
Richard, C:: Servicio de Hematología-Hemoterapia, Hospital U. Marqués de Valdecilla, Santander, Spain

Hosp U Marques de Valdecilla, Serv Hematol Hemoterapia, Santander, Spain
Santarone, S:: Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, Ospedale Civile, Pescara, Italy

Osped Civile, Dept Ematol Med Trasfus & Biotecnol, Pescara, Italy
Irrera, G:: Azienda Ospedaliera, Centro Unico Regionale Trapianti, Reggio, Calabria, Italy

Azienda Osped, Ctr Unico Reg Trapianti, Calabria, Italy
Yakoub-Agha, I:: Hôpital HURIEZ UAM allo-CSH, CHRU, Lille, France

CHRU, Hop HURIEZ UAM Allo CSH, Lille, France
Yeshurun, M:: Hematology and BMT Department, Beilinson Hospital, Petach-Tikva, Israel

Beilinson Med Ctr, Hematol & BMT Dept, Petah Tiqwa, Israel
Diez-Martin, JL:: Sección de Transplante de Medula Osea, Hospital Gregorio Marañón, Madrid, Spain

Hosp Gregorio Maranon, Secc Transplante Medula Osea, Madrid, Spain
Mohty, M:: ALWP Office, Hôpital Saint Antoine, Paris, France

Service d'Hématologie et de Thérapie Cellulaire, Hôpital Saint Antoine, Paris, France

INSERM UMR 938, Paris, France

Universite Pierre et Marie Curie, Paris, France

Hop St Antoine, ALWP Off, Paris, France

Hop St Antoine, Serv Hematol & Therapie Cellulaire, Paris, France

INSERM, UMR 938, Paris, France

Univ Paris 06, Paris, France
Savani, BN:: ALWP Office, Hôpital Saint Antoine, Paris, France

Vanderbilt University Medical Center, Nashville, TN, USA

Hop St Antoine, ALWP Off, Paris, France

Vanderbilt Univ, Med Ctr, Nashville, TN USA
Nagler, A:: ALWP Office, Hôpital Saint Antoine, Paris, France

Universite Pierre et Marie Curie, Paris, France

Division of Hematology, Chaim Sheba Medical Center, Tel Hashomer, Israel

Hop St Antoine, ALWP Off, Paris, France

Univ Paris 06, Paris, France

Chaim Sheba Med Ctr, Div Hematol, Tel Hashomer, Israel

Keywords

Allogeneic stem cell transplantation; HLA-matched related donor; Acute myeloid leukemia; In vivo T cell depletion; Graft-versus-host disease; Relapse incidence; GRFS

Campos de estudio

Proyectos asociados

RED DE INVESTIGACION COOPERATIVA DE CANCER

RD06/0020/0031 . INSTITUTO DE SALUD CARLOS III; FUNDACIÓN PARA LA INVESTIGACIÓN DEL HOSPITAL UNIVERSITARIO LA FE DE LA COMUNIDAD VALENCIANA . 2006

PROYECTO CAIBER

CAI08/01/0061 . INSTITUTO DE SALUD CARLOS III; FUNDACIÓN PARA LA INVESTIGACIÓN DEL HOSPITAL UNIVERSITARIO LA FE DE LA COMUNIDAD VALENCIANA . 2009

CREACION Y MEJORA DE INFRAESTRUCTURAS EN MEDICINA REGENERATIVA

Investigador Principal: FUNDACIÓN PARA LA INVESTIGACIÓN DEL HOSPITAL UNIVERSITARIO LA FE DE LA COMUNIDAD VALENCIANA

PLE2009-0141 ACI-PLAN E . MINISTERIO DE CIENCIA E INNOVACION; FUNDACIÓN PARA LA INVESTIGACIÓN DEL HOSPITAL UNIVERSITARIO LA FE DE LA COMUNIDAD VALENCIANA . 2009