A 2-step approach to myeloablative haploidentical stem cell transplantation: a phase 1/2 trial performed with optimized T-cell dosing.

Authors

• Dolores Grosso
• Matthew Carabasi
• Joanne Filicko-O'Hara
• Margaret Kasner
• John L Wagner
• Beth Colombe
• Patricia Cornett Farley
• William O'Hara
• Phyllis Flomenberg
• Maria Werner-Wasik
• Janet Brunner
• Bijoyesh Mookerjee
• Terry Hyslop
• Mark Weiss
• Neal Flomenberg

Publication/Presentation Date

10-27-2011

Abstract

Studies of haploidentical hematopoietic stem cell transplantation (HSCT) have identified threshold doses of T cells below which severe GVHD is usually absent. However, little is known regarding optimal T-cell dosing as it relates to engraftment, immune reconstitution, and relapse. To begin to address this question, we developed a 2-step myeloablative approach to haploidentical HSCT in which 27 patients conditioned with total body irradiation (TBI) were given a fixed dose of donor T cells (HSCT step 1), followed by cyclophosphamide (CY) for T-cell tolerization. A CD34-selected HSC product (HSCT step 2) was infused after CY. A dose of 2 × 10(8)/kg of T cells resulted in consistent engraftment, immune reconstitution, and acceptable rates of GVHD. Cumulative incidences of grade III-IV GVHD, nonrelapse mortality (NRM), and relapse-related mortality were 7.4%, 22.2%, and 29.6%, respectively. With a follow-up of 28-56 months, the 3-year probability of overall survival for the whole cohort is 48% and 75% in patients without disease at HSCT. In the context of CY tolerization, a high, fixed dose of haploidentical T cells was associated with encouraging outcomes, especially in good-risk patients, and can serve as the basis for further exploration and optimization of this 2-step approach. This study is registered at www.clinicaltrials.gov as NCT00429143.

Volume

118

Issue

17

First Page

4732

Last Page

4739

ISSN

1528-0020

Published In/Presented At

Grosso, D., Carabasi, M., Filicko-O'Hara, J., Kasner, M., Wagner, J. L., Colombe, B., Cornett Farley, P., O'Hara, W., Flomenberg, P., Werner-Wasik, M., Brunner, J., Mookerjee, B., Hyslop, T., Weiss, M., & Flomenberg, N. (2011). A 2-step approach to myeloablative haploidentical stem cell transplantation: a phase 1/2 trial performed with optimized T-cell dosing. Blood, 118(17), 4732–4739. https://doi.org/10.1182/blood-2011-07-365338

Disciplines

Medicine and Health Sciences

PubMedID

21868572

Department(s)

Hematology-Medical Oncology Division

Document Type

Article