Published online 18 July 2008
Haematologica, Vol 93, Issue 9, 1343-1350 doi:10.3324/haematol.12665
Copyright © 2008 by Ferrata Storti Foundation

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Multiple Myeloma

Clinical impact of human Jurkat T-cell-line-derived antithymocyte globulin in multiple myeloma patients undergoing allogeneic stem cell transplantation

Francis Ayuk¹, José A. Perez-Simon², Avichai Shimoni³, Anna Sureda⁴, Tatjana Zabelina¹, Rainer Schwerdtfeger⁵, Rodrigo Martino⁴, Herbert Gottfried Sayer⁶, Adrián Alegre⁷, Juan-José Lahuerta⁸, Djordje Atanackovic⁹, Christine Wolschke¹, Arnon Nagler³, Axel R. Zander¹, Jesús F. San Miguel², Nicolaus Kröger¹

¹ Department. of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
² Department of Hematology, Hospital Clínico Universitario, Salamanca, Spain
³ Department of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
⁴ Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
⁵ Department of Bone Marrow Transplantation, DKD-Clinic, Wiesbaden, Germany
⁶ Department of Oncology and Hematology, University of Jena, Germany
⁷ Hospital de la Princesa, Madrid, Spain
⁸ Hospital 12 de Octubre, Madrid, Spain
⁹ Department of Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Correspondence: Nicolaus Kröger, Dept of Stem cell Transplantation, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany E-mail:nkroeger{at}uke.uni-hamburg.de

Background: Antithymocyte globulin or human Jurkat T-cell-line-derived antilymphocyte globulin is used in allogeneic stem cell transplantation to induce in vivo T-cell depletion to facilitate engraftment and lower graft-versus-host disease. In vitro studies suggest that antithymocyte globulin, besides causing T-cell depletion, has strong anti-myeloma activity.

Design and Methods: We evaluated the anti-myeloma activity of antilymphocyte globulin in a melphalan/fludarabine-based reduced intensity conditioning regimen as well as the incidence of graft-versus-host disease in 138 multiple myeloma patients who underwent allogeneic stem cell transplantation with (n=79) or without (n=59) antilymphocyte globulin.

Results: Leukocyte and platelet engraftment were faster in the group not receiving antilymphocyte globulin (13 vs. 16 days, p<0.001 and 11 vs. 19 days, p< 0.001, respectively). Inclusion of antithy-mocyte globulin led to a better day 100 overall response rate (93% vs. 78%, p=0.03) and complete response rate (59% vs. 39%, p=0.04), to a lower incidence of both acute grade III/IV graft-versus-host-disease (11% vs. 22%, p=0.10) and chronic graft-versus-host disease (23% vs. 65%, p<0.001) and to a trend to improved event-free survival at 3 years (39% vs. 27%, p=0.5). There was no difference in the estimated cumulative incidence of treatment-related mortality at 1 year between the groups receiving or not antilymphocyte globulin (25% vs. 26%). In a multivariate analysis treatment with antilymphocyte globulin was the only significant factor for achievement of a complete remission (RR:2.57, p=0.02).

Conclusions: Inclusion of antithymocyte globulin in allogeneic stem cell transplantation protocols for patients with multiple myeloma may increase remission rates and at the same time prevent graft-versus-host disease with no increase of relapses.

Key words: multiple myeloma, antithymocyte globulin, antilymphocyte globulin, allogeneic stem cell transplantation, reduced intensity conditioning.

This article has been cited by other articles:

				G. Gahrton and B. Bjorkstrand Allogeneic transplantation in multiple myeloma Haematologica, September 1, 2008; 93(9): 1295 - 1300. [Full Text] [PDF]