Naive T-Cell Depletion Prevents Chronic GVHD in Transplantation Survivors

Researchers in three phase III clinical trials transplanted T cell–depleted peripheral blood stem cells from HLA-matched related or unrelated donors into 138 patients with acute leukemia following conditioning with high- or intermediate-dose total-body irradiation and chemotherapy. Patients also received tacrolimus, with or without methotrexate or mycophenolate mofetil, as GVHD prophylaxis.

They found that although 71% of patients developed grade 2 or lower acute GVHD, it progressed to chronic GVHD in only 7% of patients—and was considered mild in most of those cases. At three years’ follow-up, overall survival was 77%; chronic GVHD-free, relapse-free survival 68%; relapse 23%; and nonrelapse mortality 8%.

“The approach results in very low incidences of severe acute and any chronic GVHD, without apparent excess risks of relapse or nonrelapse mortality, distinguishing this novel graft engineering strategy from other hematopoietic cell transplantation approaches,” the researchers wrote (https://ascopubs.org/doi/10.1200/JCO.21.01755) in the report.

However, more studies are needed to confirm the findings before it is implemented in practice. “We also want high survival rates and low relapse rates,” the primary author said (https://ascopubs.org/doi/10.1200/JCO.21.01755) in a subsequent interview. “Is what we’ve developed better than the standard of care? We think so, but we can’t know until we do randomized trials.” 

Learn more about GVHD in the Oncology Nursing Podcast Episode 206: Graft-Versus-Host Disease: Biomarkers and Beyond (https://www.ons.org/podcasts/episode-206-graft-versus-host-disease-biomarkers-and-beyond).