Document Detail


The effects of Campath 1H upon graft-versus-host disease, infection, relapse, and immune reconstitution in recipients of pediatric unrelated transplants.
MedLine Citation:
PMID:  17448918     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Graft-versus-host disease (GVHD) is a cause of serious morbidity and mortality in >50% of recipients of unrelated hematopoietic stem cell transplantation (HSCT). We performed a trial using Campath 1 H pre- and post-HSCT in an attempt to decrease the incidence of GVHD without increasing the risk of infection or relapse. Patients were retrospectively compared to a population of patients who received antithymocyte globulin (ATG) pre- and post-HSCT. Twenty-seven patients were evaluated for this study. Fourteen patients received Campath 1H and 13 patients received ATG. Demographics of patients who received Campath 1H consisted of 9 males and 5 females, with a median age of 13 years (3-17.8 years). Thirteen patients received unrelated bone marrow and 1 patient received unrelated PBSC. Demographics of patients receiving ATG consisted of 9 males, 4 females with a median age of 7.4 years (21 months-19 years). Twelve patients received unrelated bone marrow and 1 patient received unrelated PBSC. Diagnoses were similar between the 2 groups. Patients who received Campath1H received a total dose of 52 mg/m(2) pre-HSCT and 20 mg/m(2) post-HSCT. Patients who received ATG received a total dose of 60 mg/kg pre-HSCT and 100 mg/kg post-HSCT. GVHD prophylaxis and supportive care measures were similar in both groups, including aggressive antimicrobial therapy. There was a significant difference in the incidence of severe (grade III and grade IV) GVHD between the 2 groups (Campath [0 of 14] versus ATG [6 of 13], P = .006). Among the patients who were transplanted for leukemia, there was no significant difference between the 2 groups in terms of relapse (Campath [2 of 14] versus ATG [4 of 9], P = 0.16). The 100-day survival between the 2 groups was not significantly different. Patients receiving Campath 1H had the presence of CD3(+) T cells (>30 cells/mL) in their peripheral blood later than in those who received ATG (64.5 days [Campath 1H] versus 27days [ATG], P = .001). The median time to the development of a normal PHA response occurred later in the Campath 1H arm (283 days[(Campath 1H] versus 88 days [ATG], P = .0001). The median time to an antigen specific response also occurred later in those receiving Campath 1H (365 days [Campath 1H] versus 150 days [ATG], P = .004). There was no significant difference between the 2 groups in terms of fungal or viral infections. Campath 1H is effective in decreasing the incidence of GVHD without increasing the risk of relapse. Although there is a significant delay in immune reconstitution, there was no increase in infectious complications or relapse in recipients of Campath 1H. Further studies are warranted to assess if a lack of difference in infection rates are still demonstrated in larger cohorts.
Authors:
Ami J Shah; Neena Kapoor; Gay M Crooks; Kenneth I Weinberg; Hisham Abdel Azim; Renna Killen; Lily Kuo; Teresa Rushing; Donald B Kohn; Robertson Parkman
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, N.I.H., Extramural     Date:  2007-03-23
Journal Detail:
Title:  Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation     Volume:  13     ISSN:  1083-8791     ISO Abbreviation:  Biol. Blood Marrow Transplant.     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-04-23     Completed Date:  2007-06-19     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  9600628     Medline TA:  Biol Blood Marrow Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  584-93     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, Keck School of Medicine, Los Angeles, California, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Antibodies, Monoclonal / therapeutic use*
Antibodies, Monoclonal, Humanized
Antibodies, Neoplasm / therapeutic use*
Antigens, CD3 / drug effects*,  immunology
Antilymphocyte Serum / therapeutic use
Child
Child, Preschool
Female
Graft vs Host Disease / prevention & control*
Hematopoietic Stem Cell Transplantation / adverse effects,  methods*
Humans
Kaplan-Meier Estimate
Male
T-Lymphocytes / classification,  drug effects*
Transplantation, Homologous / adverse effects
Grant Support
ID/Acronym/Agency:
M01 RR00043/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Antibodies, Monoclonal, Humanized; 0/Antibodies, Neoplasm; 0/Antigens, CD3; 0/Antilymphocyte Serum; 3A189DH42V/alemtuzumab

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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