The Effects of Campath 1H upon Graft-Versus-Host Disease, Infection, Relapse, and Immune Reconstitution in Recipients of Pediatric Unrelated Transplants

• Published in: Biology of blood and marrow transplantation 2007-05, Vol.13 (5), p.584-593
• Main Authors: Shah, Ami J, Kapoor, Neena, Crooks, Gay M, Weinberg, Kenneth I, Azim, Hisham Abdel, Killen, Renna, Kuo, Lily, Rushing, Teresa, Kohn, Donald B, Parkman, Robertson
• Format: Article
• Language: English
• Subjects: Adolescent; Alemtuzumab; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Antibodies, Neoplasm - therapeutic use; Antilymphocyte Serum - therapeutic use; Campath 1H; CD3 Complex - drug effects; CD3 Complex - immunology; Child; Child, Preschool; Female; Graft vs Host Disease - prevention & control; Graft-versus-host disease; Hematology, Oncology and Palliative Medicine; Hematopoietic stem cell transplantation; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Humans; Immune reconstitution; Kaplan-Meier Estimate; Male; T-Lymphocytes - classification; T-Lymphocytes - drug effects; Transplantation, Homologous - adverse effects
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2007.01.076

Abstract 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/m2 pre-HSCT and 20 mg/m2 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