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Prepublished online as a Blood First Edition Paper on July 12, 2002; DOI 10.1182/blood-2002-03-0701. This Article Full Text Full Text (PDF) All Versions of this Article: 2002-03-0701v1 2002-03-0701v2 100/9/3121    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Pérez-Simón, J. A. Articles by Mackinnon, S. Search for Related Content PubMed PubMed Citation Articles by Pérez-Simón, J. A. Articles by Mackinnon, S. Related Collections Transplantation Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  Blood, 1 November 2002, Vol. 100, No. 9, pp. 3121-3127 CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS Nonmyeloablative transplantation with or without alemtuzumab: comparison between 2 prospective studies in patients with lymphoproliferative disorders José A. Pérez-Simón, Panagiotis D. Kottaridis, Rodrigo Martino, Charles Craddock, Dolores Caballero, Raj Chopra, Javier García-Conde, Don W. Milligan, Stephen Schey, Alvaro Urbano-Ispizua, Anne Parker, Angel Leon, Kwee Yong, Ana Sureda, Ann Hunter, Jordi Sierra, Anthony H. Goldstone, David C. Linch, Jesus F. San Miguel, and Stephen Mackinnon for the Spanish and United Kingdom Collaborative Groups for Nonmyeloablative Transplantation From the Department of Hematology, Hospital Universitairo de Salamanca, Spain; University College London Hospital, England; Hospital Santa Crev i Sant Pau, Barcelona, Spain; Heartlands and University Hospitals, Birmingham, England; Hospital Clinico de Valencia, Spain; Christie Hospital, Mancester, England; Hospital Clinic i Provincial Barcelona, Spain; Guys Hospital, London, England; Hospital de Jerez, Spain; Leicester Royal Infirmary, England. Although nonmyeloablative conditioning regimen transplantations (NMTs) induce engraftment of allogeneic stem cells with a low spectrum of toxicity, graft-versus-host disease (GVHD) remains a significant cause of morbidity and mortality. In vivo T-cell depletion, using alemtuzumab, has been shown to reduce the incidence of GVHD. However, this type of maneuver, although reducing GVHD, may have an adverse impact on disease response, because NMTs exhibit their antitumor activity by relying on a graft-versus-malignancy effect. To explore the efficacy of alemtuzumab compared with methotrexate (MTX) for GVHD prophylaxis, we have compared the results in 129 recipients of a sibling NMT enrolled in 2 prospective studies for chronic lymphoproliferative disorders. Both NMTs were based on the same combination of fludarabine and melphalan, but the United Kingdom regimen (group A) used cyclosporin A plus alemtuzumab, whereas the Spanish regimen (group B) used cyclosporin A plus MTX for GVHD prophylaxis. Patients receiving alemtuzumab had a higher incidence of cytomegalovirus (CMV) reactivation (85% versus 24%, P < .001) and a significantly lower incidence of acute GVHD (21.7% versus 45.1%, P = .006) and chronic GVHD (5% versus 66.7%, P < .001). Twenty-one percent of patients in group A and 67.5% in group B had complete or partial responses 3 months after transplantation (P < .001). Eighteen patients in group A received donor lymphocyte infusions (DLIs) to achieve disease control. At last follow-up there was no difference in disease status between the groups with 71% versus 67.5% (P = .43) of patients showing complete or partial responses in groups A and B, respectively. No significant differences were observed in event-free or overall survival between the 2 groups. In conclusion, alemtuzumab significantly reduced GVHD but its use was associated with a higher incidence of CMV reactivation. Patients receiving alemtuzumab often required DLIs to achieve similar tumor control but the incidence of GVHD was not significantly increased after DLI. © 2002 by The American Society of Hematology.   CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: N. 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