Campath-1 Abs 'in the bag' for hematological malignancies: the Cape Town experience.

Abstract

We examined the strategy of T-cell depletion of HLA-identical sibling grafts for the prevention of GvHD, as well as disease control and overall survival. The myeloablative conditioning was radiation based. The source of stem cells was BM in 62, and cytokine-mobilized PBPC in 68 patients. GvHD prophylaxis was by ex vivo incubation of the stem-cell concentrates with Campath-1G (anti-CD52; n=76) or Campath-1H (n=54). Patients receiving PBPC grafts were older (median 38.5) than those undergoing BMT (median 31; P=0.002). More patients in the PBPC group developed chronic GvHD (p<0.01). While no post-transplant GvHD prophylaxis was given to BMT recipients, prednisone 30 mg daily was prescribed to 12 and CYA for 90 days to a further 32 patients who had received PBPC grafts. Median follow-up was 1055 (range 28-4867) days. Although there was no difference in the survival between patients who received BMT or PBPC, death was from disease recurrence in 16 and nine (p=0.03; chi(2) test) subjects, respectively. Multivariate analysis showed that outcome was particularly favorable in those who were given<20 mg Campath-1 (survival: 28/39 versus 12/29; P=0.01), and in the subgroup of 30 patients who received Campath-1H and post-transplantation CYA. In patients receiving BMT, Campath-1 Abs effectively prevent GvHD. For those treated with PBPC grafts, the combination of T-cell depletion and post-transplantation CYA is equally effective, without an obvious increase in disease recurrence.