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Transplantation of t‐lymphocyte depleted marrow with an addback of T cells
Author(s) -
Clark Richard E.,
Pender Norman
Publication year - 1995
Publication title -
hematological oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 44
eISSN - 1099-1069
pISSN - 0278-0232
DOI - 10.1002/hon.2900130406
Subject(s) - medicine , immunosuppression , transplantation , graft versus host disease , bone marrow , surgery , lymphocyte , immunology , t cell , gastroenterology , immune system
Abstract Depletion of T‐lymphocytes from allogeneic marrow prior to transplantation decreases the risk of serious graft versus host disease (GvHD), but also increases the risk of relapse. We have used a partial T‐cell depletion technique, in the hope of controlling GvHD without compromising relapse risk. Allogeneic marrow was fully T‐cell depleted ex vivo with Campath 1M, and infused together with an‘addback’ of 2 × 10 5 donor peripheral blood T‐cells/kg in 16 consecutive patients undergoing BMT from HLA‐identical family members. Post‐transplant immunosuppression was with cyclosporin A in conventional dosage. Eight cases developed grade I or II GvHD, limited to the skin in all cases. Only the two grade II cases required steroid therapy; the remainder were easily controlled with simple emollients. No cases of more advanced GvHD were seen. All patients engrafted promptly. With a median follow‐up for the survivors of 976 days, seven cases have relapsed, with an overall projected actuarial disease‐free survival of 37.5 per cent at 36 months. The overall outcome (good control of GvHD but high relapse rate) is therefore similar to that expected in patients receiving fully T‐depleted marrow without post‐transplant immunosuppression.