Barge R M Y, Starrenburg C W J, Falkenburg J H F, Fibbe W E, Marijt E W, Willemze R
Department of Hematology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
Bone Marrow Transplant. 2006 Jun;37(12):1129-34. doi: 10.1038/sj.bmt.1705385.
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.
移植物抗宿主病（GVHD）是异基因干细胞移植（alloSCT）后导致死亡和发病的主要原因，但可通过去除移植物中的T淋巴细胞来预防。Campath（抗CD52）抗体已广泛用于常规和减低强度预处理方案后的体内T细胞清除。体内使用Campath与GVHD显著降低相关，但代价是免疫重建受损。我们评估了73例采用HLA相同的同胞供者进行清髓性异基因干细胞移植的长期结果，使用“袋内”Campath作为体外T细胞清除方法。所有患者均植入，造血恢复顺利，alloSCT后3个月时供者嵌合体中位数为99%。53%的患者发生了巨细胞病毒（CMV）再激活。由于抢先使用（缬）更昔洛韦治疗，未观察到CMV疾病。急性移植物抗宿主病（aGVHD）的发生率较低（II级为22%）。未观察到III-IV级aGVHD，19%的患者发生了广泛的慢性移植物抗宿主病（cGVHD）。GVHD的低发生率和成功的抢先抗病毒治疗导致移植相关死亡率（TRM）低至8%。16例患者在alloSCT后因疾病复发死亡，则alloSCT后5年的总生存率为48%。
