Salvage immunotherapy using donor leukocyte infusions as treatment for relapsed chronic myelogenous leukemia after allogeneic bone marrow transplantation: efficacy and toxicity of a defined T-cell dose
Salvage immunotherapy using donor leukocyte infusions as treatment for relapsed chronic myelogenous leukemia after allogeneic bone marrow transplantation: efficacy and toxicity of a defined T-cell dose
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使用供体白细胞输注的挽救性免疫疗法治疗同种异体骨髓移植后复发的慢性粒细胞白血病：特定 T 细胞剂量的功效和毒性
DOI：
10.1182/blood.v82.8.2310.bloodjournal8282310
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发表时间：
1993
期刊：
影响因子：
20.3
通讯作者：
M. Horowitz
中科院分区：
文献类型：
--
作者：
W. Drobyski;C. Keever;Rőth;S. Koethe;G. Hanson;P. McFadden;J. Gottschall;R. Ash;P. Tuinen;M. Horowitz
对8例异基因骨髓移植后血液学复发的慢性粒细胞白血病（CML）患者进行了自体白细胞输注治疗。所有患者以前都接受过HLA相同同胞的骨髓移植。六名患者处于疾病的加速期，两名处于爆炸危机。每例患者接受预定的T细胞剂量，范围较窄，为2.5至5.0 × 10（8）T细胞/kg。3名患者在输注白细胞后的最初几周内还接受了α干扰素的短期治疗，以控制升高的白色血细胞计数。8例可评价患者中有7例在初始输注后中位数32天发生移植物抗宿主病（GVHD）。1例患者发生致死性GVHD。第二名患者患有3级急性GVHD，对免疫抑制治疗有反应。其余患者均为轻度I级GVHD。6例患者在输注后6个月以上继续需要中等剂量的泼尼松。4名患者发生骨髓再生障碍，其中3名患者需要从原始供体那里获得骨髓。这三名患者中的两名具有正常的造血功能，而第三名患者仍然依赖生长因子和输血。在急变期接受治疗的两名患者都已死亡，一名死于GVHD，另一名死于疾病进展。加速期的所有6例患者均存活，并且在输注后中位42周时细胞遗传学缓解。这6名患者中有5名处于分子缓解期。这项研究表明，白细胞输注，管理一个定义的T细胞剂量可以发挥深刻的移植物抗白血病的作用，是一种有效的形式的补救免疫治疗异基因骨髓移植受体。这种治疗方法似乎是一个可行的替代现有的化疗和免疫调节策略，用于治疗复发性CML。
Eight patients who had hematologic relapse of chronic myelogenous leukemia (CML) after undergoing allogeneic bone marrow transplantation (BMT) were treated with leukocyte infusions from the original bone marrow donors. All patients had previously received marrow grafts from HLA-identical siblings. Six patients were in the accelerated phase of their disease and two were in blast crisis. Each patient received a predetermined T-cell dose within a narrow range of 2.5 to 5.0 x 10(8) T cells/kg. Three patients also received short courses of therapy with alpha interferon to control elevated white blood cell counts within the first several weeks after leukocyte transfusions. Seven of eight evaluable patients developed graft-versus-host disease (GVHD) at a median of 32 days after the initial infusion. One patient had fatal GVHD. A second patient had grade 3 acute GVHD, which has responded to immunosuppressive therapy. The remaining patients all had mild grade I GVHD. Six patients continue to require modest doses of prednisone more than 6 months after infusion. Four patients developed marrow aplasia, which in three patients required marrow boosts from the original donors. Two of these three patients have normal hematopoietic function, whereas the third patient remains growth factor and transfusion dependent. Both patients treated in blast crisis have died, one from GVHD and one from disease progression. All six patients in the accelerated phase are alive and in cytogenetic remission at a median of 42 weeks after infusion. Five of these six patients are in molecular remission. This study demonstrates that leukocyte infusions that administered a defined T-cell dose can exert a profound graft-versus- leukemia effect and are an effective form of salvage immunotherapy in allogeneic marrow transplant recipients. This therapeutic approach appears to be a viable alternative to existing chemotherapeutic and immunomodulatory strategies for the treatment of relapsed CML.
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影响因子：
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作者：
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影响因子：
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通讯作者：
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