High Alloreactivity of Low-Dose Prophylactic Donor Lymphocyte Infusion in Patients with Acute Leukemia Undergoing Allogeneic Hematopoietic Cell Transplantation with an Alemtuzumab-Containing Conditioning Regimen
High Alloreactivity of Low-Dose Prophylactic Donor Lymphocyte Infusion in Patients with Acute Leukemia Undergoing Allogeneic Hematopoietic Cell Transplantation with an Alemtuzumab-Containing Conditioning Regimen
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DOI：
10.1016/j.bbmt.2012.07.021
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发表时间：
2013-01-01
影响因子：
4.3
通讯作者：
Spyridonidis, Alexandros
中科院分区：
文献类型：
--
作者：
Liga, Maria;Triantafyllou, Evangelia;Spyridonidis, Alexandros
预防性供体淋巴细胞输注（pDLI）的价值尚不清楚，并且因疾病和移植方案而异。这种方法在急性白血病患者接受造血细胞移植（HCT）与阿仑单抗结合调理方案的经验是缺乏的。我们进行了一项单中心前瞻性研究，探讨预防性供体淋巴细胞输注（pDLI）在接受HCT治疗的白血病患者中低剂量阿仑单抗治疗方案的适用性和有效性。纳入标准为高风险急性髓性白血病、急性淋巴细胞白血病或混合嵌合增多。所有纳入的患者均逐渐停止免疫治疗。排除标准为>= II级或活动性移植物抗宿主病（GVHD）病史。在56例连续接受含阿仑单抗方案HCT的患者中，15例患者（8例急性骨髓性白血病和7例急性淋巴细胞性白血病）符合研究纳入标准，并接受了预防性DLI（共45次输注），来自7名兄弟姐妹供者和8名非亲属供者。第一次输注是在移植后162天进行的。CD3（+）细胞累积剂量中位数为2 × 10(6)个/kg。在混合嵌合中接受pDLI的8例患者中，有6例（75%）转化为稳定、完全的供体嵌合。在中位累积剂量为2 × 10(6)个CD3（+）细胞/kg后，约47%的DLI受者发生GVHD（4例急性GVHD， 3例慢性GVHD）。中位随访575天后，11名（73%）pDLI受者存活。所有4例死亡均与gvhd相关。接受pDLIs治疗的患者均无复发。接受阿仑单抗治疗后接受低剂量pDLI治疗的白血病患者复发风险低；然而，这种方法与严重GVHD的发病率相对较高有关。(C) 2013年美国血液和骨髓移植学会。
The value of prophylactic donor lymphocyte infusion (pDLI) is unclear and differs among diseases and transplantation protocols. Experience with this approach in patients with acute leukemia undergoing hematopoietic cell transplantation (HCT) with an alemtuzumab-incorporating conditioning protocol is lacking. We conducted a single-center prospective study to investigate the applicability and efficacy of prophylactic donor lymphocyte infusion (pDLI) in patients with leukemia undergoing HCT with a low-dose alemtuzumab-containing conditioning regimen. Inclusion criteria were high-risk acute myelogenous leukemia, acute lymphoblastic leukemia, or increasing mixed chimerism. All patients included were tapered off of immunotherapy. Exclusion criteria were a history of >= grade II or active graft-versus-host disease (GVHD). Of the 56 consecutive patients who underwent HCT with an alemtuzumab-containing regimen, 15 patients (8 with acute myelogenous leukemia and 7 with acute lymphoblastic leukemia) met the study inclusion criteria and received prophylactic DLI (total of 45 infusions) from 7 sibling donors and 8 unrelated donors. The first infusion was given at a median of 162 days posttransplantation. The median number of DLIs was 3, and the median cumulative CD3(+) cell dose was 2 x 10(6)cells/kg. Six of the 8 patients (75%) who received pDLI while in mixed chimerism converted to stable, complete donor chimerism. Some 47% of DLI recipients developed GVHD (4 acute GVHD and 3 with chronic GVHD) after a median cumulative dose of 2 x 10(6) CD3(+) cells/kg. After a median follow-up of 575 days, 11(73%) pDLI recipients were alive. All 4 deaths were due to GVHD-related causes. None of the patients who received pDLIs relapsed. Patients with leukemia who received low-dose pDLI after conditioning with alemtuzumab are at low risk for relapse; however, this approach is associated with a relatively high incidence of severe GVHD. (C) 2013 American Society for Blood and Marrow Transplantation.