Should we T cell deplete sibling grafts for acute myeloid leukaemia in first remission?
- 18 November 2003
- journal article
- Published by Springer Nature in Bone Marrow Transplantation
- Vol. 32 (11) , 1039-1050
- https://doi.org/10.1038/sj.bmt.1704281
Abstract
There is controversy regarding the best approach to the management of patients with acute myeloid leukaemia (AML) in first remission (CR1). The impact of matched related allogeneic transplant in CR1 on the overall survival is equivocal, but what is not in doubt is a significant reduction in the relapse risk, compared to both autologous transplants and intensive chemotherapy, which is because of the allogeneic or the graft-versus-leukaemia (GVL) effect. Yet, this does not always translate to improved survival. T cell depletion (TCD) can reduce deaths related to graft-versus-host disease (GVHD) and its therapy, but might increase the relapse risk. The existing literature suggests that TCD is associated with a disease-free survival (DFS) of 53-80% and is associated with a lower relapse risk than anticipated (0-30%). We discuss the evolution of TCD in allogeneic transplantation and its relevance in AML-CR1 with regard to GVHD, DFS, immune reconstitution and GVL effect. It is possible that by reducing TRM related to GVHD and extramedullary toxicities, particularly in the older patients, TCD might improve the impact of allogeneic transplantation in AML-CR1, provided the immune reconstitution and the relapse risk are not adversely affected. Randomised studies are underway to address these issues.Keywords
This publication has 94 references indexed in Scilit:
- T‐cell depletion with Campath‐1H ‘in the bag’ for matched related allogeneic peripheral blood stem cell transplantation is associated with reduced graft‐versus‐host disease, rapid immune constitution and improved survivalBritish Journal of Haematology, 2003
- Leucyl-leucine methyl ester-treated haploidentical donor lymphocyte infusions can mediate graft-versus-leukemia activity with minimal graft-versus-host disease riskTransplantation and Cellular Therapy, 2002
- Transplantation of mobilized peripheral blood cells to HLA-identical siblings with standard-risk leukemiaBlood, 2002
- Effectiveness of Donor Natural Killer Cell Alloreactivity in Mismatched Hematopoietic TransplantsScience, 2002
- Acute myeloid leukaemia cells secrete a soluble factor that inhibits T and NK cell proliferation but not cytolytic function – implications for the adoptive immunotherapy of leukaemiaClinical and Experimental Immunology, 2001
- HLA class I-minor histocompatibility antigen tetramers select cytotoxic T cells with high avidity to the natural ligandThe Hematology Journal, 2000
- THE PHENOTYPE AND RECONSTITUTION OF IMMUNOREGULATORY T CELL SUBSETS AFTER T CELL-DEPLETED ALLOGENEIC AND AUTOLOGOUS BONE MARROW TRANSPLANTATIONTransplantation, 1994
- Graft rejection following HLA matched T‐lymphocyte depleted bone marrow transplantationBritish Journal of Haematology, 1986
- QUANTITATION OF T LYMPHOCYTES IN HUMAN BONE MARROW BY A LIMITING DILUTION ASSAYTransplantation, 1985
- REMOVAL OF MARROW T CELLS WITH OKT3-OKT11 MONOCLONAL ANTIBODIES AND COMPLEMENT TO PREVENT ACUTE GRAFT-VERSUS-HOST DISEASETransplantation, 1985