Multicenter Experience Using Total Lymphoid Irradiation and Antithymocyte Globulin as Conditioning for Allografting in Hematological Malignancies

Giuseppe Messina, Luisa Giaccone, Moreno Festuccia, Giuseppe Irrera, Ilaria Scortechini, Roberto Sorasio, Federica Gigli, Roberto Passera, Irene Cavattoni, Andrea Riccardo Filippi, Fabrizio Carnevale Schianca, Massimo Pini, Antonio M. Risitano, Carmine Selleri, Alessandro Levis, Nicola Mordini, Andrea Gallamini, Rocco Pastano, Marco Casini, Massimo AgliettaMauro Montanari, Giuseppe Console, Mario Boccadoro, Umberto Ricardi, Benedetto Bruno

Research output: Contribution to journalArticlepeer-review

Abstract

A non myeloablative conditioning with total lymphoid irradiation (TLI) and antithymocyte globulin (ATG) was shown to protect against graft-versus-host disease (GVHD). To evaluate the effects of TLI-ATG in a multicenter study, 45 heavily pretreated patients, median age 51, with lymphoid (n = 38) and myeloid (n = 7) malignancies were enrolled at 9 centers. Twenty-eight patients (62%) received at least 3 lines of treatment before allografting, and 13 (29%) had refractory/relapsed disease at the time of transplantation. Peripheral blood hematopoietic cells were from HLA identical sibling (n = 30), HLA-matched (n = 9), or 1 antigen HLA-mismatched (n = 6) unrelated donors. A cumulative TLI dose of 8 Gy was administered from day -11 through -1 with ATG at the dose of 1.5 mg/kg/day (from day -11 through -7). GVHD prophylaxis consisted of cyclosporine and mycophenolate mofetil. Donor engraftment was reached in 95% of patients. Grade II to IV acute GVHD (aGVHD) developed in 6 patients (13.3%), and in 2 of these patients, it developed beyond day 100. Incidence of chronic GVHD (cGVHD) was 35.8%. One-year nonrelapse mortality was 9.1%. After a median follow-up of 28 months (range, 3-57 months) from transplantation, median overall survival was not reached, whereas median event-free survival was 20 months. This multicenter experience confirms that TLI-ATG protects against GVHD and maintains graft-vs-tumor effects.

Original languageEnglish
Pages (from-to)1600-1607
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume18
Issue number10
DOIs
Publication statusPublished - Oct 2012

Keywords

  • Graft-versus-host disease
  • Nonmyeloablative conditioning
  • Total lymphoid irradiation/antithymocyte globulin

ASJC Scopus subject areas

  • Transplantation
  • Hematology

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