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

C. K. Lee, M. de Magalhaes-Silverman, Raymond Hohl, M. Hayashi, J. Buatti, B. C. Wen, A. Schlueter, R. G. Strauss, R. D. Gingrich

Research output: Contribution to journalReview article

13 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)121-128
Number of pages8
JournalBone Marrow Transplantation
Volume31
Issue number2
DOIs
StatePublished - Jan 1 2003

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Homologous Transplantation
Graft vs Host Disease
Bone Marrow Transplantation
Tissue Donors
T-Lymphocytes
Transplants
Lymphocytes
Survival
Recurrence
Disease-Free Survival
Incidence
Unrelated Donors
Mortality
Virus Diseases
Cyclosporine
Pneumonia
Multivariate Analysis
Bone Marrow

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

Cite this

Lee, C. K., de Magalhaes-Silverman, M., Hohl, R., Hayashi, M., Buatti, J., Wen, B. C., ... 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), 121-128. https://doi.org/10.1038/sj.bmt.1703803
Lee, C. K. ; de Magalhaes-Silverman, M. ; Hohl, Raymond ; Hayashi, M. ; Buatti, J. ; Wen, B. C. ; Schlueter, A. ; Strauss, R. G. ; Gingrich, R. D. / Donor T-lymphocyte infusion for unrelated allogeneic bone marrow transplantation with CD3+ T-cell-depleted graft. In: Bone Marrow Transplantation. 2003 ; Vol. 31, No. 2. pp. 121-128.
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title = "Donor T-lymphocyte infusion for unrelated allogeneic bone marrow transplantation with CD3+ T-cell-depleted graft",
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.",
author = "Lee, {C. K.} and {de Magalhaes-Silverman}, M. and Raymond Hohl and M. Hayashi and J. Buatti and Wen, {B. C.} and A. Schlueter and Strauss, {R. G.} and Gingrich, {R. D.}",
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Lee, CK, de Magalhaes-Silverman, M, Hohl, R, Hayashi, M, Buatti, J, Wen, BC, Schlueter, A, Strauss, RG & Gingrich, RD 2003, 'Donor T-lymphocyte infusion for unrelated allogeneic bone marrow transplantation with CD3+ T-cell-depleted graft', Bone Marrow Transplantation, vol. 31, no. 2, pp. 121-128. https://doi.org/10.1038/sj.bmt.1703803

Donor T-lymphocyte infusion for unrelated allogeneic bone marrow transplantation with CD3+ T-cell-depleted graft. / Lee, C. K.; de Magalhaes-Silverman, M.; Hohl, Raymond; Hayashi, M.; Buatti, J.; Wen, B. C.; Schlueter, A.; Strauss, R. G.; Gingrich, R. D.

In: Bone Marrow Transplantation, Vol. 31, No. 2, 01.01.2003, p. 121-128.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Donor T-lymphocyte infusion for unrelated allogeneic bone marrow transplantation with CD3+ T-cell-depleted graft

AU - Lee, C. K.

AU - de Magalhaes-Silverman, M.

AU - Hohl, Raymond

AU - Hayashi, M.

AU - Buatti, J.

AU - Wen, B. C.

AU - Schlueter, A.

AU - Strauss, R. G.

AU - Gingrich, R. D.

PY - 2003/1/1

Y1 - 2003/1/1

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 × 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.

AB - 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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U2 - 10.1038/sj.bmt.1703803

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JO - Bone Marrow Transplantation

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