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

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

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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

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

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    Lee, C. K., de Magalhaes-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), 121-128. https://doi.org/10.1038/sj.bmt.1703803