Timing of Alemtuzumab with Respect to Day of Bone Marrow Infusion and its Effects upon Engraftment and Graft-Versus-Host Disease in Patients with Sickle Cell Disease: A Single-Institutional Study
J Pediatr Hematol Oncol
© 2020 Wolters Kluwer Health, Inc. All rights reserved. The possible impact of "late"alemtuzumab (administered on days-10 to-8) versus "early"alemtuzumab (-19 to-17) with respect to engraftment and acute/chronic graft-versus-host disease (GvHD) in a group of 25 pediatric patients with sickle cell disease undergoing bone marrow transplantation following conditioning with alemtuzumab, fludarabine, and melphalan is reported. The first 9 patients received "late"alemtuzumab followed by bone marrow transplantation from HLA-matched sibling donors. The next 16 patients undergoing matched sibling transplants received "early"alemtuzumab. In the "late"group, 1 patient (11%) developed acute GvHD. Six patients (67%) achieved sustained engraftment. Three patients (33%) experienced graft rejection, leading to termination of enrollment of patients on this regimen. In the "early"alemtuzumab group, acute and chronic GvHD developed in 43% and 25% patients, respectively. None of the patients experienced graft rejection in this group of patients. Three patients developed stable mixed chimerism and 13 patients demonstrated 100% donor chimerism at 1 year post-transplant and beyond. These results suggest a benefit with respect to engraftment of administering "early"versus "late"alemtuzumab in this reduced-intensity conditioning regimen, however, with the possible cost of an increase in acute, and possibly chronic GvHD.
e718 - e722
School of Medicine