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Long-term follow-up of myeloablative allogeneic stem cell transplantation using Campath 'in the bag' as T-cell depletion: the Leiden experience.

Barge RM, Starrenburg CW, Falkenburg JH, Fibbe WE, Marijt EW, Willemze R

1Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands.

Graft-versus-host disease (GVHD) is a major cause of mortality and morbidity after allogeneic stem cell transplantation (alloSCT) but can be prevented by removing T-lymphocytes from the graft. Campath (anti-CD52) antibodies have been widely used in vivo for T-cell depletion following conventional and reduced intensity conditioning regimens. The use of Campath in vivo was associated with a significant reduction in GVHD but at the cost of impaired immune reconstitution. We evaluated the long-term outcome of 73 myeloablative allogeneic stem cell transplants with HLA-identical sibling donors using Campath 'in the bag' as method of in vitro T-cell depletion. All patients engrafted and hematopoietic recovery was uneventful, resulting in a median of 99% donor chimerism at 3 months after alloSCT. Cytomegalovirus (CMV) reactivation occurred in 53% of the patients. No CMV disease was observed probably as a result of pre-emptive (val)ganciclovir treatment. The incidence of aGVHD was low (22% grade II). No grades III-IV aGVHD was observed and extensive chronic GVHD (cGVHD) occurred in 19% of the patients. The low incidence of GVHD and successful pre-emptive antiviral therapy resulted in low TRM of 8%. Sixteen patients died due to disease relapse after alloSCT, resulting in an overall survival of 48% at 5-years after alloSCT.Bone Marrow Transplantation (2006) 37, 1129-1134. doi:10.1038/sj.bmt.1705385.

Published 7 June 2006 in Bone Marrow Transplant, 37(12): 1129-34.
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