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Selective depletion of CD8+ T lymphocytes for prevention of graft-
versus-host disease after allogeneic bone marrow transplantation
R Champlin, W Ho, J Gajewski, S Feig, M Burnison, G Holley, P Greenberg, K Lee, I Schmid and J Giorgi
Division of Hematology/Oncology, UCLA Center for Health Sciences.
The effects of selectively depleting CD8+ cells from donor bone marrow were
assessed in 36 patients receiving transplantation from an HLA- identical
sibling as treatment for leukemia. Donor bone marrow underwent ex vivo
treatment using anti-Leu-2 monoclonal antibody and complement. Patients
received cyclosporine post-transplant for 6 months. Thirty-three patients
had initial engraftment. Three failed to have hematologic recovery, and one
patient with initial engraftment had late graft failure. The actuarial
incidence of grade greater than or equal to 2 acute graft-versus-host
disease was 28% +/- 18% and was usually confined to the skin. Of 33
patients with engraftment, 32 were complete chimeras and one had mixed
chimerism. The tempo of hematologic and immunologic recovery was comparable
with that reported with transplantation of unmodified bone marrow, although
CD4+ and CD8+ T cells recovered at comparable rates. The actuarial rate of
leukemia relapse was 11% +/- 10%, occurring in three patients with acute
leukemia but in none of 13 patients transplanted for chronic myelogenous
leukemia. Actuarial survival was 57% +/- 17% at 2 years. These data
indicate that after transplantation of marrow depleted of CD8+ cells,
engraftment with prompt hematologic and immunologic recovery generally
occurs, with a relatively low rate of acute graft- versus-host disease.
Graft failure remains a problem despite retention of CD4+ cells within the
donor marrow. The lack of leukemia relapse in patients with chronic
myelogenous leukemia suggests retention of a graft-versus-leukemia effect,
at least for this malignancy.
Volume 76,
Issue 2,
pp. 418-423,
07/15/1990
Copyright © 1990 by The American Society of Hematology
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