Effect of in vivo lymphocyte-depleting strategies on development of lymphoproliferative disorders in children post allogeneic bone marrow transplantation

Brian A Lynch, M. A. Vasef, M. Comito, A. L. Gilman, N. Lee, J. Ritchie, S. Rumelhart, M. Holida, F. Goldman

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

T cell depletion (TCD) of marrow is a proven method of graft-versus-host disease (GVHD) prophylaxis in allogeneic bone marrow transplantation (BMT). Nonetheless, TCD is associated with an increased risk of developing post transplant lymphoproliferative disorder (PTLD). Between 1986 and 1998, 241 pediatric patients at the University of Iowa underwent BMT using ex vivo TCD of marrow from mismatched related or matched unrelated donors. Additional GVHD prophylaxis included anti-thymocyte globulin (ATG) or anti lymphocyte globulin (ALG) post transplant (in vivo TCD). A total of 30 cases of PTLD were identified based upon a combination of clinical, histological, and immunological features. Nearly all cases occurred within 3 months post BMT. A statistically significant increase in PTLD incidence was noted for patients treated with ATG vs ALG (33 vs 9%). While grade I-II acute GVHD was more common in patients receiving ATG vs ALG, no difference in grade III-IV GVHD or overall survival was noted between the two groups. Assessment of immune recovery at various times post BMT revealed significantly fewer T cells in the ATG-treated group, suggesting the deleterious effect of ATG may be due to excessive depletion of donor-derived Epstein-Barr virus-specific cytotoxic T cells. Thus, caution should be exercised in the use of anti-T-cell antibody therapy for additional GVHD prophylaxis in the setting of TCD BMT.

Original languageEnglish (US)
Pages (from-to)527-533
Number of pages7
JournalBone Marrow Transplantation
Volume32
Issue number5
DOIs
StatePublished - Sep 2003
Externally publishedYes

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Lymphoproliferative Disorders
Homologous Transplantation
Bone Marrow Transplantation
Antilymphocyte Serum
Lymphocytes
Graft vs Host Disease
T-Lymphocytes
Globulins
Transplants
Bone Marrow
Unrelated Donors
Cell- and Tissue-Based Therapy
Human Herpesvirus 4
Tissue Donors
Pediatrics
Survival
Antibodies
Incidence

Keywords

  • Anti-thymocyte globulin
  • Bone marrow transplantation
  • Post transplant lymphoproliferative disorders
  • T-cell depletion

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Effect of in vivo lymphocyte-depleting strategies on development of lymphoproliferative disorders in children post allogeneic bone marrow transplantation. / Lynch, Brian A; Vasef, M. A.; Comito, M.; Gilman, A. L.; Lee, N.; Ritchie, J.; Rumelhart, S.; Holida, M.; Goldman, F.

In: Bone Marrow Transplantation, Vol. 32, No. 5, 09.2003, p. 527-533.

Research output: Contribution to journalArticle

Lynch, Brian A ; Vasef, M. A. ; Comito, M. ; Gilman, A. L. ; Lee, N. ; Ritchie, J. ; Rumelhart, S. ; Holida, M. ; Goldman, F. / Effect of in vivo lymphocyte-depleting strategies on development of lymphoproliferative disorders in children post allogeneic bone marrow transplantation. In: Bone Marrow Transplantation. 2003 ; Vol. 32, No. 5. pp. 527-533.
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