dc.contributor.author | Davies, JK | en_US |
dc.contributor.author | Hassan, S | en_US |
dc.contributor.author | Sarker, S-J | en_US |
dc.contributor.author | Besley, C | en_US |
dc.contributor.author | Oakervee, H | en_US |
dc.contributor.author | Smith, M | en_US |
dc.contributor.author | Taussig, D | en_US |
dc.contributor.author | Gribben, JG | en_US |
dc.contributor.author | Cavenagh, JD | en_US |
dc.date.accessioned | 2017-09-21T13:44:43Z | |
dc.date.available | 2017-09-01 | en_US |
dc.date.issued | 2018-02 | en_US |
dc.date.submitted | 2017-09-05T17:18:05.196Z | |
dc.identifier.uri | http://qmro.qmul.ac.uk/xmlui/handle/123456789/25815 | |
dc.description.abstract | Allogeneic haematopoietic stem-cell transplantation remains the only curative treatment for relapsed/refractory acute myeloid leukaemia (AML) and high-risk myelodysplasia but has previously been limited to patients who achieve remission before transplant. New sequential approaches employing T-cell depleted transplantation directly after chemotherapy show promise but are burdened by viral infection and require donor lymphocyte infusions (DLI) to augment donor chimerism and graft-versus-leukaemia effects. T-replete transplantation in sequential approaches could reduce both viral infection and DLI usage. We therefore performed a single-arm prospective Phase II clinical trial of sequential chemotherapy and T-replete transplantation using reduced-intensity conditioning without planned DLI. The primary endpoint was overall survival. Forty-seven patients with relapsed/refractory AML or high-risk myelodysplasia were enrolled; 43 proceeded to transplantation. High levels of donor chimerism were achieved spontaneously with no DLI. Overall survival of transplanted patients was 45% and 33% at 1 and 3 years. Only one patient developed cytomegalovirus disease. Cumulative incidences of treatment-related mortality and relapse were 35% and 20% at 1 year. Patients with relapsed AML and myelodysplasia had the most favourable outcomes. Late-onset graft-versus-host disease protected against relapse. In conclusion, a T-replete sequential transplantation using reduced-intensity conditioning is feasible for relapsed/refractory AML and myelodysplasia and can deliver graft-versus-leukaemia effects without DLI. | en_US |
dc.format.extent | 346 - 355 | en_US |
dc.language | eng | en_US |
dc.language.iso | en | en_US |
dc.relation.ispartof | Br J Haematol | en_US |
dc.rights | This is a pre-copyedited, author-produced version of an article accepted for publication in British Journal of Haematology following peer review. The version of record is available http://onlinelibrary.wiley.com/doi/10.1111/bjh.14980/abstract | |
dc.subject | T-replete | en_US |
dc.subject | acute myeloid leukaemia | en_US |
dc.subject | myelodysplasia | en_US |
dc.subject | sequential conditioning | en_US |
dc.subject | stem cell transplantation | en_US |
dc.subject | Adult | en_US |
dc.subject | Aged | en_US |
dc.subject | Female | en_US |
dc.subject | Graft Survival | en_US |
dc.subject | Graft vs Host Disease | en_US |
dc.subject | Graft vs Leukemia Effect | en_US |
dc.subject | Hematopoietic Stem Cell Transplantation | en_US |
dc.subject | Humans | en_US |
dc.subject | Leukemia, Myeloid, Acute | en_US |
dc.subject | Lymphocyte Depletion | en_US |
dc.subject | Male | en_US |
dc.subject | Middle Aged | en_US |
dc.subject | Myelodysplastic Syndromes | en_US |
dc.subject | Recurrence | en_US |
dc.subject | Remission Induction | en_US |
dc.subject | Transplantation Chimera | en_US |
dc.subject | Transplantation Conditioning | en_US |
dc.subject | Transplantation, Homologous | en_US |
dc.subject | Treatment Outcome | en_US |
dc.subject | Virus Activation | en_US |
dc.subject | Young Adult | en_US |
dc.title | Durable graft-versus-leukaemia effects without donor lymphocyte infusions - results of a phase II study of sequential T-replete allogeneic transplantation for high-risk acute myeloid leukaemia and myelodysplasia. | en_US |
dc.type | Article | |
dc.rights.holder | © 2017 John Wiley & Sons Ltd | |
dc.identifier.doi | 10.1111/bjh.14980 | en_US |
pubs.author-url | https://www.ncbi.nlm.nih.gov/pubmed/29076145 | en_US |
pubs.issue | 3 | en_US |
pubs.notes | 12 months | en_US |
pubs.notes | none | en_US |
pubs.publication-status | Published | en_US |
pubs.volume | 180 | en_US |
dcterms.dateAccepted | 2017-09-01 | en_US |