Journal article
Donor T-lymphocyte infusion for unrelated allogeneic bone marrow transplantation with CD3+ T-cell-depleted graft
Bone marrow transplantation (Basingstoke), Vol.31(2), pp.121-128
2003
DOI: 10.1038/sj.bmt.1703803
PMID: 12621494
Abstract
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.
Details
- Title: Subtitle
- Donor T-lymphocyte infusion for unrelated allogeneic bone marrow transplantation with CD3+ T-cell-depleted graft
- Creators
- C.-K LEE - Division of Hematology, Oncology, Blood & Marrow Transplantation, Department of Internal Medicine. College of Medicine, The University of Iowa, IA, United StatesM DEMAGALHAES-SILVERMAN - Division of Hematology, Oncology, Blood & Marrow Transplantation, Department of Internal Medicine. College of Medicine, The University of Iowa, IA, United StatesR. J HOHL - Division of Hematology, Oncology, Blood & Marrow Transplantation, Department of Internal Medicine. College of Medicine, The University of Iowa, IA, United StatesM HAYASHI - Division of Hematology, Oncology, Blood & Marrow Transplantation, Department of Internal Medicine. College of Medicine, The University of Iowa, IA, United StatesJ BUATTI - Division of Radiation Oncology, Department of Radiology, College of Medicine, The University of Iowa, IA, United StatesB.-C WEN - Department of Radiation Oncology, The University of Miami, Miami, FL, United StatesA SCHLUETER - Department of Pathology, College of Medicine, The University of Iowa, IA, United StatesR. G STRAUSS - Department of Pathology and Pediatrics, College of Medicine, The University of Iowa, IA, United StatesR. D GINGRICH - Division of Hematology, Oncology, Blood & Marrow Transplantation, Department of Internal Medicine. College of Medicine, The University of Iowa, IA, United States
- Resource Type
- Journal article
- Publication Details
- Bone marrow transplantation (Basingstoke), Vol.31(2), pp.121-128
- DOI
- 10.1038/sj.bmt.1703803
- PMID
- 12621494
- NLM abbreviation
- Bone Marrow Transplant
- ISSN
- 0268-3369
- eISSN
- 1476-5365
- Publisher
- Nature Publishing Group; Basingstoke
- Language
- English
- Date published
- 2003
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Stead Family Department of Pediatrics; Pathology; Radiation Oncology; Neurosurgery; Otolaryngology; Internal Medicine
- Record Identifier
- 9984040263502771
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