T Cell Depletion of Donor Marrow for Prevention of Acute Graft-Versus-Host Disease

Abstract

Allogeneic bone marrow transplantation can provide curative therapy for patients with acute leukemia or aplastic anemia. However, acute graft-versus-host disease (GVHD) occurs in a high proportion of patients, even when the donor is an HLA genotypically identical sibling. Observations that GVHD can be prevented in rodent models by removing mature T cells from the donor marrow have prompted similar investigations in human bone marrow transplantation. These investigations have been facilitated recently by the availability of monoclonal antibodies that recognize surface molecules expressed by T lymphocytes and not by hematopoietic precursors. In Seattle, 20 patients 31–50 years of age with hematologic malignancies received HLA identical allogeneic bone marrow grafts depleted of T lymphocytes with the use of monoclonal antibodies and rabbit serum complement. The patients were prepared for transplantation with cyclophosphamide (60 mg/kg, two doses) and fractionated total body irradiation. Ciclosporine was administered after transplantation for prophylaxis of GVHD.

Fred Hutchinson Cancer Research Center, Puget Sound Blood Center, Seattle, Wa 98104 and the Department of Medicine, Division of Oncology, University of Washington, Seattle, WA 98195, USA