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Lymphocyte depletion of donor bone marrow by counterflow centrifugal
elutriation: results of a phase I clinical trial
JE Wagner, AD Donnenberg, SJ Noga, CA Cremo, IK Gao, HJ Yin, GB Vogelsang, S Rowley, R Saral and GW Santos
Oncology Center, Johns Hopkins University School of Medicine, Baltimore, MD
21205.
We report here the results of a phase I clinical trial using counterflow
centrifugal elutriation (CCE) for the removal of donor T lymphocytes before
allogeneic bone marrow transplantation (BMT). Thirty- eight patients
received lymphocyte-depleted allografts from HLA- identical,
MLR-nonreactive sibling donors. The patients entered onto the study were
either at high risk on the basis of age (median, 39 years) or disease
status (acute leukemia in early relapse [ER], chronic myelogenous leukemia
[CML] in accelerated phase [AP], or therapy resistant [RES] lymphoma). All
patients received a standard lymphocyte dose of 1 x 10(6) morphologic
lymphocytes per kilogram ideal body weight (BW) and were maintained on
cyclosporine A (CsA) for 170 days after BMT. Prompt engraftment occurred in
37 of 38 patients with a median time to absolute neutrophil count (ANC)
greater than 500/microL of 18 days. Although acute graft-v-host disease
(GVHD; clinical stage I or greater) was observed in 45%, it was limited to
the skin in all but five patients. Survival was related to disease status
at the time of BMT. Among patients with acute leukemia in first or second
remission, CML in chronic phase (CP) or lymphoma in partial remission (PR),
64% are currently alive, in contrast to 31% of patients with acute leukemia
in third remission or early relapse, CML in second CP or AP, or RES
lymphoma. Median follow-up for all patients was 351 days (range, 105 to 711
days). We conclude that this procedure is safe and warrants further
evaluation in a randomized efficacy trial.
Volume 72,
Issue 4,
pp. 1168-1176,
10/01/1988
Copyright © 1988 by The American Society of Hematology
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