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| The toxicity and efficacy of donor lymphocyte infusions given after reduced-intensity conditioning allogeneic stem cell transplantation |
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| Author(s): Marks DI, Lush R, Cavenagh J, Milligan DW, Schey S, Parker A, Clark FJ, Hunt L, Yin J, Fuller S, Vandenberghe E, Marsh J, Littlewood T, Smith GM, Culligan D, Hunter A, Chopra R, Davies A, Towlson K, Williams CD |
| Source: BLOOD Volume: 100 Issue: 9 Pages: 3108-3114 Published: NOV 1 2002 |
| Times Cited: 106 References: 18 |
| Abstract: We describe the toxicity and efficacy of donor lymphocyte infusions (DLIs) given to 81 patients (median age, 50 years) after reduced-intensity conditioning (RIC) transplantations performed at 16 centers in the United Kingdom. The diseases treated included non-Hodgkin lymphoma (NHL; n = 29), chronic myeloid leukemia (CML; n = 12), myeloma (n = 11), acute myeloid leukemia (AML; n = 10), and chronic lymphocytic leukemia (CLL; In = 9). Eighty-eight percent received stem cells from sibling donors. The patients received 130 infusions (median, 1; range, 1-4). Indications for DLI were unsatisfactory response/disease progression in 51 patients, mixed chimerism in 18, preemptive in 10, and other in 2. Graft hypoplasia was uncommon (11%). Grade 11 to IV graft-versus-host disease (GVHD) occurred in 23 of 81 patients (28%) and limited and extensive chronic GVHD in 5 of 69 and 18 of 69 evaluable, patients (total incidence 33%). Conversion from mixed to full donor chimerism occurred in 19 of 55 evaluable patients (35%) at a median of 48 days after the DLI; partial responses occurred in 6 patients (total response rate 45%). Eighteen of 51 (35%) patients with measurable disease after stem cell transplantation had a complete response (2 molecular), and 5 a partial response (total response rate 45%). Eleven of 17 evaluable complete responders had full donor chimerism. Eight of 13 patients with follicular NHL had complete responses as did 4 of 12 patients with CML. Clinical and chimeric responses correlated strongly with acute and chronic GVHD. Forty-seven patients (58%) survive at a median of 508 days after transplantation (range, 155-1171 days) with a median Karnofsky score of 90. Thirty-four patients (42%) died at a median of 211 days after transplantation with the major causes being progressive disease (26%) and GVHD (9%). Further systematic studies are required to determine the efficacy and optimum use of DLI for patients with each disease treated by nonmyeloablative stem cell transplantation. (C) 2002 by The American Society of Hematology. |
| Document Type: Article |
| Language: English |
| Reprint Address: Marks, DI (reprint author), Bristol Childrens Hosp, Bristol Adult BMT Unit, Upper Maudlin St, Bristol BS2 8BJ, Avon England |
Addresses:
1. City Hosp Nottingham, Dept Haematol, Nottingham, England
2. St Bartholomews & Royal London NHS Trust, Dept Haematol, London, England
3. Birmingham Heartlands Hosp, Dept Haematol, Birmingham B9 5ST, W Midlands England
4. Guys & St Thomas NHS Trust, Dept Haematol, London, England
5. Glasgow Royal Infirm, Dept Haematol, Glasgow G4 0SF, Lanark Scotland
6. Queen Elizabeth Hosp, Dept Haematol, Birmingham B15 2TH, W Midlands England
7. Manchester Royal Infirm, Dept Haematol, Manchester M13 9WL, Lancs England
8. Hammersmith Hosp, Dept Haematol, London, England
9. Royal Hallamshire Hosp, Dept Haematol, Sheffield S10 2JF, S Yorkshire England
10. St George Hosp, Dept Haematol, London, England
11. John Radcliffe Hosp, Dept Haematol, Oxford OX3 9DU, England
12. Leeds Blood & Marrow Transplant Ctr, Dept Haematol, Leeds, W Yorkshire England
13. Aberdeen Royal Infirm, Dept Haematol, Aberdeen, Scotland
14. Leicester Royal Infirm, Dept Haematol, Leicester, Leics England
15. Christie Hosp, Dept Haematol, Manchester, Lancs England |
| Publisher: AMER SOC HEMATOLOGY, 1900 M STREET. NW SUITE 200, WASHINGTON, DC 20036 USA |
| Subject Category: Hematology |
| IDS Number: 608AE |
| ISSN: 0006-4971 |
| DOI: 10.1182/blood-2002-02-0508 |
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