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Related Experiment Videos

Using elutriation to engineer bone marrow allografts.

S J Noga1, J E Wagner, S D Rowley

  • 1Bone Marrow Transplantation Unit, Johns Hopkins Oncology Center, Baltimore, Maryland 21205.

Progress in Clinical and Biological Research
|January 1, 1990
PubMed
Summary
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Elutriation effectively reduces graft-versus-host disease (GVHD) incidence and severity in allogeneic bone marrow transplants (BMT). However, it increases leukemia relapse rates, necessitating new strategies to improve long-term remission and survival.

Area of Science:

  • Hematology
  • Immunology
  • Transplantation

Background:

  • Allogeneic bone marrow transplantation (BMT) is a critical treatment for hematologic malignancies.
  • Graft-versus-host disease (GVHD) and graft failure are significant complications following BMT.
  • Reducing lymphocyte dose in marrow allografts is a strategy to mitigate GVHD.

Purpose of the Study:

  • To evaluate the safety and efficacy of lymphocyte depletion by elutriation in allogeneic BMT.
  • To assess the impact of varying lymphocyte doses on engraftment, GVHD, and survival.
  • To investigate the effect of elutriation on leukemia relapse rates.

Main Methods:

  • Elutriation was used to deplete lymphocytes from marrow allografts in 64 patients across three study phases.
  • Lymphocyte doses were standardized (1 x 10^6 or 5 x 10^5 lymphocytes/kg) and confirmed by flow cytometry.

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  • Engraftment, acute GVHD (AGVHD), survival, and relapse rates were monitored.

    • Main Results:

    • Nearly all patients in studies I and III engrafted successfully (median ANC > 500/µl in 19 days).
    • Study II, with only 4 patients, was terminated due to graft failure in 3 patients.
    • Study III showed a significant reduction in AGVHD (20% mild) compared to Study I (44% moderate), with no organ or chronic GVHD observed.
    • Actuarial survival was 42% at 38 months overall (38% Study I, 80% Study III).
    • Leukemia relapse rates were higher in elutriated marrow recipients (60% and 46% remission at 16 months for higher and lower doses, respectively).

    Conclusions:

    • Elutriation is a reproducible method for reducing AGVHD incidence and severity in allogeneic BMT.
    • Lymphocyte depletion by elutriation, while reducing GVHD, is associated with an increased risk of leukemia relapse.
    • New strategies, potentially involving altered conditioning regimens or manipulation of accessory cells, are needed to address relapse post-elutriation BMT.