alexa Donor leukocyte infusions in 140 patients with relapsed malignancy after allogeneic bone marrow transplantation.


Journal of Carcinogenesis & Mutagenesis

Author(s): Collins RH Jr, Shpilberg O, Drobyski WR, Porter DL, Giralt S,

Abstract Share this page

Abstract PURPOSE: Recipients of allogeneic bone marrow transplants (BMTs) who have relapsed may attain complete remissions when treated with transfusions of leukocytes obtained from the original bone marrow donor. We performed a retrospective study to characterize better this new treatment modality. PATIENTS AND METHODS: We surveyed 25 North American BMT programs regarding their use of donor leukocyte infusions (DLI). Detailed forms were used to gather data regarding the original BMT, relapse, DLI, response to DLI, complications of DLI, and long-term follow-up evaluation. Reports of 140 patients were thus available for analysis. RESULTS: Complete responses were observed in 60\% (95\% confidence interval [CI], 51.9\% to 68.1\%) of chronic myelogenous leukemia (CML) patients who received DLI and did not receive pre-DLI chemotherapy; response rates were higher in patients with cytogenetic and chronic-phase relapse (75.7\%; 95\% CI, 68.2\% to 83.2\%) than in patients with accelerated-phase (33.3\%; 95\% CI, 19.7\% to 46.9\%) or blastic-phase (16.7\%; 95\% CI, 1.9\% to 31.9\%) relapse. The actuarial probability of remaining in complete remission at 2 years was 89.6\%. Complete remission rates in acute myelogenous leukemia (AML) (n = 39) and acute lymphocytic leukemia (ALL) (n = 11) patients who had not received pre-DLI chemotherapy were 15.4\% (95\% CI, 9.6\% to 21.2\%) and 18.2\% (95\% CI, 6.6\% to 29.8\%), respectively. Complete remissions were also observed in two of four assessable myeloma patients and two of five assessable myelodysplasia patients. Complications of DLI included acute graft-versus-host disease (GVHD) (60\%; 95\% CI, 51.4\% to 68.6\%), chronic GVHD (60.7\%; 95\% CI, 50.3\% to 71.1\%), and pancytopenia (18.6\%; 95\% CI, 12.2\% to 25.0\%). Pre-DLI characteristics predictive of complete response in CML patients were post-BMT chronic GVHD, pre-DLI disease status of chronic phase, and time interval between BMT to DLI less than 2 years. Acute and chronic GVHD post-DLI were highly correlated with disease response (P < .00001). CONCLUSION: DLI results in complete remissions in a high percentage of patients with relapsed chronic-phase CML. Complete remissions are observed less frequently in patients with advanced CML and acute leukemia. GVHD and pancytopenia occur commonly; GVHD is highly correlated with response.
This article was published in J Clin Oncol and referenced in Journal of Carcinogenesis & Mutagenesis

Relevant Expert PPTs

Relevant Speaker PPTs

Recommended Conferences

Peer Reviewed Journals
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version