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

TY - JOUR

T1 - 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

AU - Nikolousis, E.

AU - Robinson, S.

AU - Nagra, S.

AU - Brookes, C.

AU - Kinsella, F.

AU - Tauro, S.

AU - Jeffries, S.

AU - Griffiths, M.

AU - Mahendra, P.

AU - Cook, M.

AU - Paneesha, S.

AU - Lovell, R.

AU - Kishore, B.

AU - Chaganti, S.

AU - Malladi, R.

AU - Raghavan, M.

AU - Moss, P.

AU - Milligan, D.

AU - Craddock, C.

PY - 2013/5

Y1 - 2013/5

N2 - 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. (C) 2013 Elsevier Ltd. All rights reserved.

AB - 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. (C) 2013 Elsevier Ltd. All rights reserved.

KW - KINETICS

KW - MINIMAL RESIDUAL DISEASE

KW - SURVIVAL

KW - PATTERNS

KW - T cell chimerism

KW - IN-VIVO

KW - ENGRAFTMENT

KW - Reduced intensity transplant

KW - Alemtuzumab

KW - MIXED CHIMERISM

KW - BONE-MARROW-TRANSPLANTATION

KW - TOXICITY

KW - HEMATOLOGIC MALIGNANCIES

U2 - 10.1016/j.leukres.2013.01.010

DO - 10.1016/j.leukres.2013.01.010

M3 - Article

C2 - 23395505

SN - 0145-2126

VL - 37

SP - 561

EP - 565

JO - Leukemia Research

JF - Leukemia Research

IS - 5

ER -