Campath-1 Abs ‘in the bag’ for hematological malignancies: the Cape Town experience

Myeloablative conditioning is well tolerated by older patients receiving T-cell-depleted grafts

“…This prolonged immunosuppression may be related to the in vivo long biological life of the anti-CD52 antibody, as it has been detected in blood many months following its infusion. 31 Thus, the lowest possible dose of antibody (0.1 mg/10 8 mononuclear cells) was used for the ex vivo purging with and it rarely exceed 10 mg. 32,14 Although Kaplan and Meier curves show that at 2 years from transplantation patients with acute leukaemia had lower survivals than did patients with CML or lymphoproliferative malignancies, this difference was not significant (Figure 2). This may be relevant, as patients with acute leukaemia were younger (median 34 years), than those with lymphoma (median 47.5 years; Po0.01) and CML (median 39 years; P ¼ 0.02).…”

“…In addition, we also offer DLI as prophylaxis of relapse, even if on molecular studies they have remained in remission, as it is our experience that most of them will eventually progress. 14,17 However, in these patients we do not progress beyond the infusion of 1 Â 10 7 /kg CD3 cells. None of the patients so treated have shown evidence of disease relapse.…”

“…The details of our therapies have been published elsewhere. 14,16,17 Preparation for transplantation Informed consent was taken from the patients according to the guidelines at Groote Schuur Hospital and the University of Cape Town. In preparation for the procedure, a double-lumen indwelling catheter was placed into a deep thoracic vein.…”

“…The radiation-based conditioning regimen was with fractionated (f) total body irradiation (TBI) delivered in six twice daily fractions of 2 Gy (total 1200 cGy), four fractions of total lymphoid irradiation (TNI) of 1.5 Gy followed by cyclophosphamide 60 mg/kg (with mesna cover) on days À2 and À1. 14,16 Patients with multiple myeloma were also conditioned with radiotherapy but melphalan at 100 mg/ m 2 , replaced cyclophosphamide. When radiotherapy was not available, individuals received conditioning with oral busulfan 1 mg/kg  12, melphalan 70 mg/m 2 on two consecutive days (total dose 140 mg/m 2 ), followed by cyclophosphamide 120 mg/kg in two daily divided doses.…”

“…12 Depletion of T cell from the stem cell graft is the most effective strategy in the prevention of GvHD, even when a larger load of T cells are present, as occurs in a peripheral blood stem cell graft (peripheral blood progenitor cell (PBPC)). 13,14 Experience has shown that lower incidence and severity of GvHD has been associated with improvement in early outcome after transplantation and may also have a favourable impact on overall survival. 13 Thus, we postulate that in older patients, haematopoietic stem cell transplantation may be more tolerable in the absence of the deleterious effects of GvHD.…”