Multicenter experience using total lymphoid irradiation and antithymocyte globulin as conditioning for allografting in hematological malignancies |
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Authors: | Messina Giuseppe,Giaccone Luisa,Festuccia Moreno,Irrera Giuseppe,Scortechini Ilaria,Sorasio Roberto,Gigli Federica,Passera Roberto,Cavattoni Irene,Filippi Andrea Riccardo,Schianca Fabrizio Carnevale,Pini Massimo,Risitano Antonio M,Selleri Carmine,Levis Alessandro,Mordini Nicola,Gallamini Andrea,Pastano Rocco,Casini Marco,Aglietta Massimo,Montanari Mauro,Console Giuseppe,Boccadoro Mario,Ricardi Umberto,Bruno Benedetto Gruppo Italiano Trapianti di Midollo |
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Affiliation: | Centro Unico Regionale Trapianti Alberto Neri, A.O. Bianchi-Melacrino-Morelli, Reggio Calabria, Italy. |
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Abstract: | A non myeloablative conditioning with total lymphoid irradiation (TLI) and antithymocyte globulin (ATG) was shown to protect against graft-versus-host disease (GVHD). To evaluate the effects of TLI-ATG in a multicenter study, 45 heavily pretreated patients, median age 51, with lymphoid (n = 38) and myeloid (n = 7) malignancies were enrolled at 9 centers. Twenty-eight patients (62%) received at least 3 lines of treatment before allografting, and 13 (29%) had refractory/relapsed disease at the time of transplantation. Peripheral blood hematopoietic cells were from HLA identical sibling (n = 30), HLA-matched (n = 9), or 1 antigen HLA-mismatched (n = 6) unrelated donors. A cumulative TLI dose of 8 Gy was administered from day -11 through -1 with ATG at the dose of 1.5 mg/kg/day (from day -11 through -7). GVHD prophylaxis consisted of cyclosporine and mycophenolate mofetil. Donor engraftment was reached in 95% of patients. Grade II to IV acute GVHD (aGVHD) developed in 6 patients (13.3%), and in 2 of these patients, it developed beyond day 100. Incidence of chronic GVHD (cGVHD) was 35.8%. One-year nonrelapse mortality was 9.1%. After a median follow-up of 28 months (range, 3-57 months) from transplantation, median overall survival was not reached, whereas median event-free survival was 20 months. This multicenter experience confirms that TLI-ATG protects against GVHD and maintains graft-vs-tumor effects. |
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