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ctt-journal > Slesarchuk et al. (Abstract)

Slesarchuk et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 2, No. 5, 2009
doi: 10.3205/ctt-2009-No5-abstract61
© The Authors. This abstract is provided under the following license:
Creative Commons Attribution 3.0 Unported


Abstract accepted for "Joint EBMT Pediatric Working Party – 3rd Raisa Gorbacheva Memorial Meeting on Hematopoietic Stem Cell Transplantation", Saint Petersburg, Russia, September 17–20, 2009

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Efficacy of donor lymphocyte infusions following allogenic stem cell transplantation (allo-HSCT)

Olga A. Slesarchuk, Elena V. Babenko, Maria A. Estrina, Ilya V. Kazantsev, Ludmila S. Zubarovskaya, Boris V. Afanasyev

Memorial R.M. Gorbacheva Institute of Children Hematology and Transplantation, St. Petersburg Pavlov State Medical University, St. Petersburg, Russia

Correspondence: Olga A. Slesarchuk, Memorial R.M. Gorbacheva Institute of Children Hematology and Transplantation, St. Petersburg Pavlov State Medical University, 6/8, Tolstoy str., St. Petersburg, 199044, Russia, E-mail: cadet2002@mail.ru

Abstract

Purpose: To evaluate the efficacy of donor lymphocyte infusion (DLI) after allo-HSCT in patients (pts) with acute leukemia.

Patients and Methods: Data from 29 pts given allo-HSCT from HLA-matched related donors (n=12), unrelated donors (n=11), and from haploidentical family member donors (n=6) were retrospectively analyzed. The conditioning regimen was myeloablative in 13 patients and RIC in 16 patients. Underlying malignant diseases were acute myeloid leukemia (AML, n=14) and acute lymphoblastic leukemia (ALL, n=15). The indications for DLI were minimal residual disease (n=2), mixed chimerism (n=3), preemptive treatment (n=1), graft rejection (n=1), and disease relapse (n=22). Fifteen pts with disease relapse received cytoreductive chemotherapy before DLI and 7 pts received DLI alone. The total number of DLI procedures was 56. Cell dose ranged from 3х104 CD3+cells/kg to 1х108 CD3+cells/kg. Fifteen pts received DLI as a bulk dose regimen, 16 pts received an escalating dose regimen. At the moment of DLI all pts had no signs of aGVHD; however, 5 pts had cGVHD.

Results: Complete remission (CR) was obtained in 12 pts (41%): 4 (27%) of 15 pts with ALL and 8 (57%) of 14 pts with AML. GVHD grade I–II appeared in 2 (6.8%) pts, grade III–IV in 3 (10%) pts, and in 2 cases it was fatal. Seven pts relapsed after DLI. The duration of CR after DLI ranged from 2 to 11 months. Five pts (17%) after allo-HSCT and DLI are still alive and in CR. Although response rate was greater in AML then in ALL, the 3yr OS was similar for both groups: 5 (36%) and 6 (44%), respectively.

Table 1.

Diagnosis   

N   

Indications   

Treatment   

N   

CR   

Response  

3 yr OS

ALL

15 

Relapse

DLI+chemotherapy

10   

3

4 (27%)

44%

DLI

1

0

MRD

DLI

2

1

Mixed chimerism

DLI

1

0

Graft rejection

DLI

1

0

AML

14 

Relapse

DLI+chemotherapy

5

3

8 (57%)


36%

DLI

6

3

Mixed chimerism

DLI

2

2

Preemptive

DLI

1

0



Conclusions:
Using DLI is effective in pts with disease relapse after allo-HSCT. However, it is associated with a high risk of aGVHD. Strategies to use a combination of DLI with target agents for efficacy improvement should be investigated in patients after allo-HSCT.

Keywords: relapse post-HSCT, donor lymphocyte infusion, response, GVHD, cell dose

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