Work

223: Alternative Donor Hematopoietic Stem Cell Transplantation for Pediatric Patients with Acute Lymphoblastic Leukemia Using Campath in a Myeloablative Conditioning Regimen

Year: 2008

Type: article

Abstract: Allogeneic transplantation from a matched sibling donor (MSD) offers curative therapy for pediatric patients with acute lymphoblastic leukemia (ALL); however, less than 30% of patients will have a MSD. Alternative donor (AD) transplantation is a viable option for these patients, but the risk for GVHD remains much higher. From 2001 to present, we have used Campath in the conditioning regimen for AD transplants to achieve in vivo T-cell depletion, in an effort to reduce the risk of GVHD. Here we report the outcome of pediatric ALL patients receiving AD transplants using Campath as part of a myeloablative conditioning regimen. Risk assessment is assigned prior to transplant – standard risk (SR) includes patients with ALL in 1st or 2nd complete remission. Since 1997, 39 patients with SR ALL were transplanted with MSD grafts, and since instituting Campath in 2001, 39 patients have received AD grafts. AD patients received bone marrow or peripheral blood stem cell products from up to 1 antigen mismatched related or unrelated donor. Myeloablative conditioning included cyclophosphamide, cytarabine arabinoside and total body irradiation (1200 cGy for MSD and 1400 cGy for AD) in all patients with the addition of Campath in the AD recipients. Additional GVHD prophylaxis consisted of FK506 or cyclosporine with either methotrexate or prednisone. All but one evaluable patient achieved neutrophil engraftment. The 5-year disease-free survival for patients with MSD was 83% compared to 60% for AD recipients. The 100-day mortality was 8% in the AD group and 3% in the MSD group. GVHD was low in the AD cohort – 13% developed grade II-IV acute GVHD and none developed extensive, chronic GVHD. Consistent with other published reports using Campath, we did observe a high incidence of viral infections – 28% developed adenovirus reactivation; 28% developed CMV reactivation; and 3% developed EBV-LPD. We conclude that Campath used with a myeloablative conditioning regimen offers a curative option for pediatric patients with acute lymphoblastic leukemia requiring alternative donor transplantation with a low incidence of GVHD.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2007.12.232