Progress in Hematology Advances in the management of acquired aplastic anemia (AA)

International Journal of Hematology

, Volume 97, Issue 5, pp 573-580

Allogeneic stem cell transplantation using alemtuzumab-containing regimens in severe aplastic anemia

  • S. GandhiAffiliated withDepartment of Haematological Medicine, King’s College Hospital/King’s College London
  • , A. G. KulasekararajAffiliated withDepartment of Haematological Medicine, King’s College Hospital/King’s College London
  • , G. J. MuftiAffiliated withDepartment of Haematological Medicine, King’s College Hospital/King’s College London
  • , J. C. W. MarshAffiliated withDepartment of Haematological Medicine, King’s College Hospital/King’s College London Email author 

Abstract

Alemtuzumab, a humanized anti-CD52, IgG1 monoclonal antibody, is used to reduce graft-versus- host disease (GVHD) and aid engraftment after allogeneic haemopoietic stem cell transplant (HSCT). Its associated low incidence of GVHD makes it an attractive alternative to anti-thymocyte globulin (ATG) in transplant conditioning regimen for severe aplastic anaemia (SAA). We have reviewed the use of alemtuzumab-based conditioning regimen for HSCT in SAA and show that it results in sustained haematological engraftment, a very low incidence of chronic GVHD without an increase in viral infections. Intriguingly, alemtuzumab appears to induce tolerance post-HSCT with the findings of stable mixed T cell chimerism with full donor myeloid chimerism and the absence of chronic GVHD, and which persist on withdrawal of post-graft immunosuppression. Finally, its low toxicity profile may permit future application of HSCT to older patients with SAA who fail to respond to immunosuppressive therapy.

Keywords

Alemtuzumab Aplastic anemia Haemopoietic stem cell transplant (HSCT)