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Retrospective study of alemtuzumab vs ATG-based conditioning without irradiation for unrelated and matched sibling donor transplants in acquired severe aplastic anemia: a study from the British Society for Blood and Marrow Transplantation.
Bone Marrow Transplant. 2014 Jan; 49(1):42-8.BM

Abstract

This retrospective national study compared the use of alemtuzumab-based conditioning regimens for hematopoietic SCT (HSCT) in acquired severe aplastic anemia with antithymocyte globulin (ATG)-based regimens. One hundred patients received alemtuzumab and 55 ATG-based regimens. A matched sibling donor (MSD) was used in 87 (56%), matched unrelated donor (MUD) in 60 (39%) and other related or mismatched unrelated donor (UD) in 8 (5%) patients. Engraftment failure occurred in 9% of the alemtuzumab group and 11% of the ATG group. Five-year OS was 90% for the alemtuzumab and 79% for the ATG groups, P=0.11. For UD HSCT, OS of patients was better when using alemtuzumab (88%) compared with ATG (57%), P=0.026, although smaller numbers of patients received ATG. Similar outcomes for MSD HSCT using alemtuzumab or ATG were seen (91% vs 85%, respectively, P=0.562). A lower risk of chronic GVHD (cGVHD) was observed in the alemtuzumab group (11% vs 26%, P=0.031). On multivariate analysis, use of BM as stem cell source was associated with better OS and EFS, and less acute and cGVHD; young age was associated with better EFS and lower risk of graft failure. This large study confirms successful avoidance of irradiation in the conditioning regimens for MUD HSCT patients.

Authors+Show Affiliations

Department of Haematological Medicine, King's College Hospital and King's College London,, London, UK.BSBMT Data Registry, Guy's Hospital, London, UK.Department of Haematology, St George's Hospital and Medical School, London, UK.Department of Haematology-Oncology, National University Cancer Institute, National Hospital Singapore, Singapore.Department of Haematological Medicine, King's College Hospital and King's College London,, London, UK.Department of Haematological Medicine, King's College Hospital and King's College London,, London, UK.BSBMT Data Registry, Guy's Hospital, London, UK.1] Department of Haematology, Sheffield Teaching Hospitals, Sheffield, UK [2] Department of Oncology, University of Sheffield, Sheffield, UK.Department of Haematology, Sheffield Children's Hospital, Sheffield, UK.Department of Paediatric Blood and Marrow Transplant, Royal Manchester Children's Hospital, Manchester, UK.Department of Haematology, Nottingham University Hospital, Nottingham, UK.Department of Haematology, Royal Hospital for Sick Children, Glasgow, Scotland, UK.Department of Haematology, St James's Institute of Oncology, St James's University Hospital, Leeds, UK.Centre for Haematology and Transplantation, Heartlands Hospital, Birmingham, UK.Department of Haematology, Great Ormond Hospital for Sick Children, London, UK.Department of Paediatric and Adolescent Haematology, Great North Children's Hospital, Newcastle-Upon-Tyne, UK.Centre for Cancer Research and Cell Biology, Queen's University, Belfast, UK.BSBMT Data Registry, Guy's Hospital, London, UK.Department of Haematology, St James's Institute of Oncology, St James's University Hospital, Leeds, UK.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

23912664

Citation

Marsh, J C., et al. "Retrospective Study of Alemtuzumab Vs ATG-based Conditioning Without Irradiation for Unrelated and Matched Sibling Donor Transplants in Acquired Severe Aplastic Anemia: a Study From the British Society for Blood and Marrow Transplantation." Bone Marrow Transplantation, vol. 49, no. 1, 2014, pp. 42-8.
Marsh JC, Pearce RM, Koh MB, et al. Retrospective study of alemtuzumab vs ATG-based conditioning without irradiation for unrelated and matched sibling donor transplants in acquired severe aplastic anemia: a study from the British Society for Blood and Marrow Transplantation. Bone Marrow Transplant. 2014;49(1):42-8.
Marsh, J. C., Pearce, R. M., Koh, M. B., Lim, Z., Pagliuca, A., Mufti, G. J., Perry, J., Snowden, J. A., Vora, A. J., Wynn, R. T., Russell, N., Gibson, B., Gilleece, M., Milligan, D., Veys, P., Samarasinghe, S., McMullin, M., Kirkland, K., & Cook, G. (2014). Retrospective study of alemtuzumab vs ATG-based conditioning without irradiation for unrelated and matched sibling donor transplants in acquired severe aplastic anemia: a study from the British Society for Blood and Marrow Transplantation. Bone Marrow Transplantation, 49(1), 42-8. https://doi.org/10.1038/bmt.2013.115
Marsh JC, et al. Retrospective Study of Alemtuzumab Vs ATG-based Conditioning Without Irradiation for Unrelated and Matched Sibling Donor Transplants in Acquired Severe Aplastic Anemia: a Study From the British Society for Blood and Marrow Transplantation. Bone Marrow Transplant. 2014;49(1):42-8. PubMed PMID: 23912664.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Retrospective study of alemtuzumab vs ATG-based conditioning without irradiation for unrelated and matched sibling donor transplants in acquired severe aplastic anemia: a study from the British Society for Blood and Marrow Transplantation. AU - Marsh,J C, AU - Pearce,R M, AU - Koh,M B C, AU - Lim,Z, AU - Pagliuca,A, AU - Mufti,G J, AU - Perry,J, AU - Snowden,J A, AU - Vora,A J, AU - Wynn,R T, AU - Russell,N, AU - Gibson,B, AU - Gilleece,M, AU - Milligan,D, AU - Veys,P, AU - Samarasinghe,S, AU - McMullin,M, AU - Kirkland,K, AU - Cook,G, AU - ,, Y1 - 2013/08/05/ PY - 2013/04/03/received PY - 2013/05/28/revised PY - 2013/06/26/accepted PY - 2013/8/6/entrez PY - 2013/8/6/pubmed PY - 2014/9/3/medline SP - 42 EP - 8 JF - Bone marrow transplantation JO - Bone Marrow Transplant. VL - 49 IS - 1 N2 - This retrospective national study compared the use of alemtuzumab-based conditioning regimens for hematopoietic SCT (HSCT) in acquired severe aplastic anemia with antithymocyte globulin (ATG)-based regimens. One hundred patients received alemtuzumab and 55 ATG-based regimens. A matched sibling donor (MSD) was used in 87 (56%), matched unrelated donor (MUD) in 60 (39%) and other related or mismatched unrelated donor (UD) in 8 (5%) patients. Engraftment failure occurred in 9% of the alemtuzumab group and 11% of the ATG group. Five-year OS was 90% for the alemtuzumab and 79% for the ATG groups, P=0.11. For UD HSCT, OS of patients was better when using alemtuzumab (88%) compared with ATG (57%), P=0.026, although smaller numbers of patients received ATG. Similar outcomes for MSD HSCT using alemtuzumab or ATG were seen (91% vs 85%, respectively, P=0.562). A lower risk of chronic GVHD (cGVHD) was observed in the alemtuzumab group (11% vs 26%, P=0.031). On multivariate analysis, use of BM as stem cell source was associated with better OS and EFS, and less acute and cGVHD; young age was associated with better EFS and lower risk of graft failure. This large study confirms successful avoidance of irradiation in the conditioning regimens for MUD HSCT patients. SN - 1476-5365 UR - https://www.unboundmedicine.com/medline/citation/23912664/Retrospective_study_of_alemtuzumab_vs_ATG_based_conditioning_without_irradiation_for_unrelated_and_matched_sibling_donor_transplants_in_acquired_severe_aplastic_anemia:_a_study_from_the_British_Society_for_Blood_and_Marrow_Transplantation_ L2 - http://dx.doi.org/10.1038/bmt.2013.115 DB - PRIME DP - Unbound Medicine ER -