Prophylactic reinfusion of T cells for T cell-depleted allogeneic bone marrow transplantation

Choon Kee Lee, Roger D. Gingrich, Margarida DeMagalhaes-Silverman, Raymond Hohl, Jacqueline K. Joyce, Shane D. Scott, B. Chen Wen, Annette Schlueter

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

To increase the graft-vs.-leukemia (GVL) effect while maintaining a low mortality from graft-vs.-host disease (GVHD), we conducted a prospective study of T cell titration for 144 patients (90 related, 54 unrelated) between June 1994 and June 1997. Following infusion of a T cell-depleted marrow graft, predetermined doses of T cells, based on the risk factors for GVHD, were administered up to 3 times if greater than a grade II acute GVHD was not seen. Graft failure occurred in three unrelated recipients (2%). Cumulative grades II-IV acute GVHD were seen in 58 ± 9% of all recipients; 52 ± 11% related and 75 ± 13% unrelated. The incidence of grades II-IV acute GVHD following the third add-back (AB) of T cells 78 median days after marrow infusion was lower than that of the earlier ABs: first AB, 36 ± 8%; second AB, 32 ± 11%; third AB, 15 ± 12% (p < 0.05). Chronic GVHD occurred in 56 ± 12% of related and 79 ± 16% of unrelated patients. Six died of acute GVHD and two died of chronic GVHD, with an overall GVHD mortality of 6 ± 4%. In multivariate analyses, unrelated recipients and patients at low risk for GVHD who received a larger number of T cells were identified as patient groups with significant risk for acute and chronic GVHD (both p < 0.05). Unrelated transplant is also shown to be significant for GVHD-related death (p < 0.01). Relapse-free survival of patients with leukemia was shown to be most dependent on chronic GVHD and grades II-IV acute GVHD (both p < 0.01). Anti-leukemic activity independent of GVHD was not observed.

Original languageEnglish (US)
Pages (from-to)15-27
Number of pages13
JournalBiology of Blood and Marrow Transplantation
Volume5
Issue number1
DOIs
StatePublished - Jan 1 1999

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Homologous Transplantation
Bone Marrow Transplantation
T-Lymphocytes
Transplants
Leukemia
Bone Marrow
Mortality
Multivariate Analysis
Prospective Studies
Recurrence
Survival
Incidence

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

Cite this

Lee, Choon Kee ; Gingrich, Roger D. ; DeMagalhaes-Silverman, Margarida ; Hohl, Raymond ; Joyce, Jacqueline K. ; Scott, Shane D. ; Wen, B. Chen ; Schlueter, Annette. / Prophylactic reinfusion of T cells for T cell-depleted allogeneic bone marrow transplantation. In: Biology of Blood and Marrow Transplantation. 1999 ; Vol. 5, No. 1. pp. 15-27.
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abstract = "To increase the graft-vs.-leukemia (GVL) effect while maintaining a low mortality from graft-vs.-host disease (GVHD), we conducted a prospective study of T cell titration for 144 patients (90 related, 54 unrelated) between June 1994 and June 1997. Following infusion of a T cell-depleted marrow graft, predetermined doses of T cells, based on the risk factors for GVHD, were administered up to 3 times if greater than a grade II acute GVHD was not seen. Graft failure occurred in three unrelated recipients (2{\%}). Cumulative grades II-IV acute GVHD were seen in 58 ± 9{\%} of all recipients; 52 ± 11{\%} related and 75 ± 13{\%} unrelated. The incidence of grades II-IV acute GVHD following the third add-back (AB) of T cells 78 median days after marrow infusion was lower than that of the earlier ABs: first AB, 36 ± 8{\%}; second AB, 32 ± 11{\%}; third AB, 15 ± 12{\%} (p < 0.05). Chronic GVHD occurred in 56 ± 12{\%} of related and 79 ± 16{\%} of unrelated patients. Six died of acute GVHD and two died of chronic GVHD, with an overall GVHD mortality of 6 ± 4{\%}. In multivariate analyses, unrelated recipients and patients at low risk for GVHD who received a larger number of T cells were identified as patient groups with significant risk for acute and chronic GVHD (both p < 0.05). Unrelated transplant is also shown to be significant for GVHD-related death (p < 0.01). Relapse-free survival of patients with leukemia was shown to be most dependent on chronic GVHD and grades II-IV acute GVHD (both p < 0.01). Anti-leukemic activity independent of GVHD was not observed.",
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Lee, CK, Gingrich, RD, DeMagalhaes-Silverman, M, Hohl, R, Joyce, JK, Scott, SD, Wen, BC & Schlueter, A 1999, 'Prophylactic reinfusion of T cells for T cell-depleted allogeneic bone marrow transplantation', Biology of Blood and Marrow Transplantation, vol. 5, no. 1, pp. 15-27. https://doi.org/10.1053/bbmt.1999.v5.pm10232737

Prophylactic reinfusion of T cells for T cell-depleted allogeneic bone marrow transplantation. / Lee, Choon Kee; Gingrich, Roger D.; DeMagalhaes-Silverman, Margarida; Hohl, Raymond; Joyce, Jacqueline K.; Scott, Shane D.; Wen, B. Chen; Schlueter, Annette.

In: Biology of Blood and Marrow Transplantation, Vol. 5, No. 1, 01.01.1999, p. 15-27.

Research output: Contribution to journalArticle

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T1 - Prophylactic reinfusion of T cells for T cell-depleted allogeneic bone marrow transplantation

AU - Lee, Choon Kee

AU - Gingrich, Roger D.

AU - DeMagalhaes-Silverman, Margarida

AU - Hohl, Raymond

AU - Joyce, Jacqueline K.

AU - Scott, Shane D.

AU - Wen, B. Chen

AU - Schlueter, Annette

PY - 1999/1/1

Y1 - 1999/1/1

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AB - To increase the graft-vs.-leukemia (GVL) effect while maintaining a low mortality from graft-vs.-host disease (GVHD), we conducted a prospective study of T cell titration for 144 patients (90 related, 54 unrelated) between June 1994 and June 1997. Following infusion of a T cell-depleted marrow graft, predetermined doses of T cells, based on the risk factors for GVHD, were administered up to 3 times if greater than a grade II acute GVHD was not seen. Graft failure occurred in three unrelated recipients (2%). Cumulative grades II-IV acute GVHD were seen in 58 ± 9% of all recipients; 52 ± 11% related and 75 ± 13% unrelated. The incidence of grades II-IV acute GVHD following the third add-back (AB) of T cells 78 median days after marrow infusion was lower than that of the earlier ABs: first AB, 36 ± 8%; second AB, 32 ± 11%; third AB, 15 ± 12% (p < 0.05). Chronic GVHD occurred in 56 ± 12% of related and 79 ± 16% of unrelated patients. Six died of acute GVHD and two died of chronic GVHD, with an overall GVHD mortality of 6 ± 4%. In multivariate analyses, unrelated recipients and patients at low risk for GVHD who received a larger number of T cells were identified as patient groups with significant risk for acute and chronic GVHD (both p < 0.05). Unrelated transplant is also shown to be significant for GVHD-related death (p < 0.01). Relapse-free survival of patients with leukemia was shown to be most dependent on chronic GVHD and grades II-IV acute GVHD (both p < 0.01). Anti-leukemic activity independent of GVHD was not observed.

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