T- and B-cell immune reconstitution and clinical outcome in patients with multiple myeloma receiving T-cell-depleted, reduced-intensity allogeneic stem cell transplantation with an alemtuzumab-containing conditioning regimen followed by escalated donor lymphocyte infusions.

D'Sa, S; Peggs, K; Pizzey, A; Verfuerth, S; Thuraisundaram, D; Watts, M; White, H; Hale, G; Waldmann, H; Goldstone, A; Mackinnon, S; Yong, K

Journal article

T- and B-cell immune reconstitution and clinical outcome in patients with multiple myeloma receiving T-cell-depleted, reduced-intensity allogeneic stem cell transplantation with an alemtuzumab-containing conditioning regimen followed by escalated donor lymphocyte infusions.

Abstract:: Immune reconstitution after conventional allogeneic transplantation is a major determinant of survival. We conducted a detailed investigation of T- and B-cell immune reconstitution and clinical outcome in 19 patients with multiple myeloma undergoing reduced-intensity stem cell transplantation using in vivo T-cell depletion with alemtuzumab. These patients experienced delayed T-cell recovery, particularly in the naïve (CD45 RA+) CD4 compartment. T-cell receptor spectratype analysis showed a reduced repertoire diversity, which improved rapidly after the administration of donor leucocyte infusions and subsequent conversion to full donor T-cell chimaerism. Post-transplant recovery of CD19+ B cells was also delayed for up to 18 months. Spectratype analysis of IgH CDR3 repertoire revealed a gradual normalization in IgM spectratype complexity by 6-12 months after transplant. There was a high incidence of viral infection, particularly cytomegalovirus reactivation, but the regimen-related mortality was low, perhaps because of the very low incidence of acute graft-versus-host disease (GVHD; grade I-II skin GVHD was seen in 5/19 patients). Over 80% of all patients have relapsed at a median of 283 (range 153-895) d after transplant, suggesting that the initially low rate of GVHD comes at a high price with regard to the desired graft-versus-myeloma effect.

Publication status:: Published

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APA Style

D'Sa, S., Peggs, K., Pizzey, A., Verfuerth, S., Thuraisundaram, D., Watts, M., White, H., Hale, G., Waldmann, H., Goldstone, A., Mackinnon, S., & Yong, K. (2003). T- and B-cell immune reconstitution and clinical outcome in patients with multiple myeloma receiving T-cell-depleted, reduced-intensity allogeneic stem cell transplantation with an alemtuzumab-containing conditioning regimen followed by escalated donor lymphocyte infusions. British Journal of Haematology, 123(2), 309–322.

MLA Style

D'Sa, S, et al. “T- And B-Cell Immune Reconstitution and Clinical Outcome in Patients with Multiple Myeloma Receiving T-Cell-Depleted, Reduced-Intensity Allogeneic Stem Cell Transplantation with an Alemtuzumab-Containing Conditioning Regimen Followed by Escalated Donor Lymphocyte Infusions.” British Journal of Haematology, vol. 123, no. 2, 2003, pp. 309–22.

Chicago Style

D'Sa, S, K Peggs, A Pizzey, et al. 2003. “T- And B-Cell Immune Reconstitution and Clinical Outcome in Patients with Multiple Myeloma Receiving T-Cell-Depleted, Reduced-Intensity Allogeneic Stem Cell Transplantation with an Alemtuzumab-Containing Conditioning Regimen Followed by Escalated Donor Lymphocyte Infusions.” British Journal of Haematology 123 (2): 309–22.
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