International Journal of Hematology

DOI: 10.1007/s12185-013-1333-9 Pages: 573-580

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

1. King’s College Hospital/King’s College London, Department of Haematological Medicine

Correspondence to:
J. C. W. Marsh
Tel: +44-203-2994153
Email: judith.marsh@nhs.net

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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.

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