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Donor Lymphocyte Infusions

Donor T-lymphocyte infusion for unrelated allogeneic bone marrow transplantation with CD3+ T-cell-depleted graft

Bone Marrow Transplantation volume 31, pages 121–128 (2003)Cite this article

Summary:

In T-cell-depleted allogeneic bone marrow transplantation (TCD-BMT) using unrelated donors, the role of donor lymphocyte infusion (DLI) for survival and disease control has not been defined. In a study of 116 patients (92 matched, 24 mismatched) who received CD3+ T-cell-depleted marrow graft, sequential infusions of escalated doses of donor T lymphocytes up to 1×106 CD3+ cells/kg were prospectively investigated. T cells were administered while patients were on cyclosporine, provided ≥grade II acute graft-versus-host-disease (GVHD) had not occurred. Acute GVHD of ≥grade II occurred in 27 of 110 (25%) patients before DLI and in 39 of 79 (49%) patients after DLI. In total, 12 of 27 (44%) patients without DLI and 44 of 72 (61%) patients who received DLI developed chronic GVHD. A total of 19 patients died of GVHD, with 17 of acute and two of chronic GVHD. Overall survival (OS) and event-free survival (EFS) at 5 years were 27 and 21%, respectively. The 2-year incidence of relapse was 14%. In multivariate analysis, only chronic GVHD was a good prognostic factor for both OS: hazard ratio (HR) 1.4, P=0.04, and EFS: HR 1.6, P=0.01. Both acute and chronic GVHD were favorable prognostic factors for relapse probability: HR 1.9 for both, P=0.02, 0.01, respectively. The 1-year cumulative incidence of transplant-related mortality (TRM), excluding cases of GVHD, was 42%. The two most common causes of 1-year non-GVHD death were viral infection (9%) and idiopathic pneumonia syndrome (12%). Although the incidence of relapse was low, the study suggests that the current scheme of DLI in unrelated TCD-BMT would not improve survival unless TRM decreases significantly.

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Acknowledgements

We thank Colleen Chapleau for coordination for the Iowa Marrow Donor Program, Mary Dachtler for data management and all referring physicians for their dedication for the care of the patients.

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Authors and Affiliations

  1. Division of Hematology, Oncology, Blood & Marrow Transplantation, Department of Internal Medicine, College of Medicine, The University of Iowa, IA, USA

    C-K Lee, M deMagalhaes-Silverman, R J Hohl, M Hayashi & R D Gingrich

  2. Division of Radiation Oncology, Department of Radiology, College of Medicine, The University of Iowa, IA, USA

    J Buatti

  3. Department of Pathology, College of Medicine, The University of Iowa, IA, USA

    A Schlueter

  4. Department of Pathology and Pediatrics, College of Medicine, The University of Iowa, IA, USA

    R G Strauss

  5. Department of Radiation Oncology, The University of Miami, Miami, FL, USA

    B-C Wen

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Lee, CK., deMagalhaes-Silverman, M., Hohl, R. et al. Donor T-lymphocyte infusion for unrelated allogeneic bone marrow transplantation with CD3+ T-cell-depleted graft. Bone Marrow Transplant 31, 121–128 (2003). https://doi.org/10.1038/sj.bmt.1703803

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