Prophylactic T cell infusion after T cell-depleted bone marrow transplantation in patients with refractory lymphoma.
Fifty-two patients with refractory lymphoma were prospectively treated with prophylactic T lymphocyte infusion after T cell-depleted allogeneic bone marrow transplantation, to induce graft-versus-lymphoma effect. Thirty-three patients had related donors; 19 had unrelated donors. After transplantation with marrow that had 0.8 +/- 0.4 x 10(5)CD3(+) cells/kg, T cells up to 1.75 x 10(6) CD3(+) cells/kg were given over 3 months provided > or = grade II acute graft-versus-host disease (GVHD) was not seen. The cumulative incidence of grades II-IV acute GVHD was 69%. Twenty of 32 evaluable patients (63%) developed chronic GVHD. Ten patients (19%) died of GVHD. The Kaplan-Meier 5-year overall survival of all patients was 34%. On multivariate analyses, chronic GVHD was significant for relapse (hazard ratio of 1.7, P < 0.05), and for overall survival (hazard ratio 1.4, P < 0.001). Chemosensitivity was significant for relapse only on univariate analysis. Patients who developed chronic GVHD had 4 years median survival, compared with 9 months in patients without chronic GVHD, P < 0.001. The study shows that patients with chronic GVHD have superior survivals, most probably related to a graft-versus-lymphoma effect, which could be modulated by prophylactic T cell infusion.
Lee
C-K
CK
Department of Internal Medicine, Division of Hematology, Oncology, Blood and Marrow Transplantation, University of Iowa, College of Medicine, Iowa City, IA, USA.
de Magalhaes-Silverman
M
M
Hohl
R J
RJ
Hayashi
M
M
Buatti
J
J
Wen
B C
BC
Schlueter
A
A
Strauss
R G
RG
Gingrich
R D
RD
D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods*; D002423:Cause of Death; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D020350:Graft vs Tumor Effect; D006463:Hemolytic-Uremic Syndrome / Q000401:mortality; D006801:Humans; D007239:Infections / Q000401:mortality; D015993:Life Tables; D008212:Lymphocyte Depletion; D017710:Lymphocyte Transfusion; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D016019:Survival Analysis; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous