Decreased Risk of Acute Graft-versus-Host Disease Using Reduced Intensity Conditioning Compared to Myeloablative Conditioning is Independent of Donor-Recipient T-cell Chimerism
Olle Ringdén1,2*, Behnam Sadeghi1, Mehmet Uzunel1, Martin Solders1,2, Michael Uhlin1,2, Jonas Mattsson1,2 and Mats Remberger1,2
1Department of Laboratory Medicine, Division of Therapeutic Immunology, Sweden
2Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Sweden
- *Corresponding Author:
- Olle Ringdén
Karolinska Institute, Division of Therapeutic Immunology
Karolinska University Hospital Huddinge
F79, SE-141 86 Stockholm,Sweden
Tel: +46 8 585 82672
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E-mail: [email protected]
Received Date: July 15, 2014; Accepted Date: October 27, 2014; Published Date: October 29,2014
Citation: Ringdén O, Sadeghi B, Uzunel M, Solders M, Uhlin M, et al. (2014) Decreased Risk of Acute Graft-versus-Host Disease Using Reduced Intensity Conditioning Compared to Myeloablative Conditioning is Independent of Donor-Recipient T-cell Chimerism. J Transplant Technol Res 4: 142. doi: 10.4172/2161-0991.1000142
Copyright: © 2014 Ringdén O, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: It is not known if the reduced risk of graft-versus-host disease (GVHD) among patients receiving reduced intensity conditioning (RIC) as opposed to myeloablative conditioning (MAC) is due to differences in mixed donor-recipients chimerism, or to the intensity of the regimen.
We compared patients with acute myeloid leukemia
(AML) selected for RIC (n=47) to 46 patients selected for MAC before allogeneic hematopoietic stem cell transplantation (HSCT).
Time to neutrophils
>0.5 x 109/L was median 15 days in the MAC group, which was faster than 17 days in the RIC group (p=0.001). MAC patients required more erythrocytes (p=0.001) and platelet transfusions (p=0.003). At four weeks, mixed donor-recipient T-cell chimerism was seen in 29% of the MAC patients and 46% of the RIC patients. Acute GVHD grades II-IV was 55% and 17% in the two groups, respectively (p<0.001). In multivariate analysis, acute GVHD was reduced using RIC (hazards ratio (HR) 0.23, p<0.001), for year of HSCT (HR 1.27, p=0.01), but not for mixed donor-recipient T-cell chimerism (HR 1.11, p=0.80). Transplant-related mortality (TRM) at three years was 15% versus 13%. Chronic GVHD and relapse were similar. Overall mortality was not affected by conditioning (HR 1.39,
Discussion: To conclude, patients treated with RIC had an increased risk of acute GVHD as opposed to recipients of MAC, which was due to less intense conditioning and not due to mixed donor T-cell chimerism.