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Donor T-lymphocyte infusion for unrelated allogeneic bone marrow transplantation with CD3+ T-cell-depleted graft.
Bone Marrow Transplant. 2003 Jan; 31(2):121-8.BM

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 x 10(6) CD3+ cells/kg were prospectively investigated. T cells were administered while patients were on cyclosporine, provided >or=grade II acute graft-versus-host-disease (GVHD) had not occurred. Acute GVHD of >or=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.

Authors+Show Affiliations

Department of Internal Medicine, College of Medicine, The University of Iowa, IA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12621494

Citation

Lee, C-K, et al. "Donor T-lymphocyte Infusion for Unrelated Allogeneic Bone Marrow Transplantation With CD3+ T-cell-depleted Graft." Bone Marrow Transplantation, vol. 31, no. 2, 2003, pp. 121-8.
Lee CK, deMagalhaes-Silverman M, Hohl RJ, et al. Donor T-lymphocyte infusion for unrelated allogeneic bone marrow transplantation with CD3+ T-cell-depleted graft. Bone Marrow Transplant. 2003;31(2):121-8.
Lee, C. K., deMagalhaes-Silverman, M., Hohl, R. J., Hayashi, M., Buatti, J., Wen, B. C., Schlueter, A., Strauss, R. G., & Gingrich, R. D. (2003). Donor T-lymphocyte infusion for unrelated allogeneic bone marrow transplantation with CD3+ T-cell-depleted graft. Bone Marrow Transplantation, 31(2), 121-8.
Lee CK, et al. Donor T-lymphocyte Infusion for Unrelated Allogeneic Bone Marrow Transplantation With CD3+ T-cell-depleted Graft. Bone Marrow Transplant. 2003;31(2):121-8. PubMed PMID: 12621494.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Donor T-lymphocyte infusion for unrelated allogeneic bone marrow transplantation with CD3+ T-cell-depleted graft. AU - Lee,C-K, AU - deMagalhaes-Silverman,M, AU - Hohl,R J, AU - Hayashi,M, AU - Buatti,J, AU - Wen,B-C, AU - Schlueter,A, AU - Strauss,R G, AU - Gingrich,R D, PY - 2003/3/7/pubmed PY - 2003/9/25/medline PY - 2003/3/7/entrez SP - 121 EP - 8 JF - Bone marrow transplantation JO - Bone Marrow Transplant VL - 31 IS - 2 N2 - 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 x 10(6) CD3+ cells/kg were prospectively investigated. T cells were administered while patients were on cyclosporine, provided >or=grade II acute graft-versus-host-disease (GVHD) had not occurred. Acute GVHD of >or=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. SN - 0268-3369 UR - https://www.unboundmedicine.com/medline/citation/12621494/Donor_T_lymphocyte_infusion_for_unrelated_allogeneic_bone_marrow_transplantation_with_CD3+_T_cell_depleted_graft_ L2 - https://doi.org/10.1038/sj.bmt.1703803 DB - PRIME DP - Unbound Medicine ER -