title: Donor lymphocyte infusion for relapsed chronic myelogenous leukemia: prognostic relevance of the initial cell dose.
abstract: Donor lymphocyte infusion (DLI) can produce durable remissions in patients with chronic myelogenous leukemia (CML) who have a relapse after an allogeneic stem cell transplantation. However, the best modality to administer DLI is still unclear. The effect of the initial cell dose (ICD; ie, mononuclear cells x 10(8)/kg received in the first instance) on outcome was retrospectively analyzed in 298 of 344 patients treated with DLI at 51 centers. Patients were classified into 3 groups according to the ICD: 98 in group A (<or= 0.20), 107 in group B (0.21-2.0), and 93 in group C (> 2.0). Additional infusions were given to 62%, 20%, and 5% of patients in groups A, B, and C, respectively. A lower ICD was associated with less graft-versus-host disease (GVHD; A, 26%; B, 53%; C, 62%; P <.001), less myelosuppression (A, 10%; B, 23%; C, 24%; P =.01), and similar response rate (A, 78%; B, 73%; C, 70%; P =.48). Nonadjusted estimates of 3-year survival, failure-free survival, and DLI-related mortality were 84%, 66%, and 5% respectively, in group A; 63%, 57%, and 20% in group B; and 58%, 45%, and 22% in group C. Outcome analysis was adjusted for patient age, donor type, sex of donor, sex mismatch, disease phase at transplantation, T-cell depletion, interval from transplantation to DLI, GVHD prior to relapse, relapse type, and date of DLI. After adjustment, lower ICD was associated with less GVHD, less myelosuppression, same response rate, better survival, better failure-free survival, and less DLI-related mortality. Our results suggest that the first DLI dose should not exceed 0.2 x 10(8) mononuclear cells/kg.
authors.affiliation: Università La Sapienza, Dipartimento di Biotecnologie Cellulari ed Ematologia, Unità TMO Allogenico Giuseppe Papa, Rome, Italy. guglielmi@bce.uniroma1.it
authors.forename: Cesare
authors.initials: C
authors.lastname: Guglielmi
authors.forename: William
authors.initials: W
authors.lastname: Arcese
authors.forename: Francesco
authors.initials: F
authors.lastname: Dazzi
authors.forename: Ronald
authors.initials: R
authors.lastname: Brand
authors.forename: Donald
authors.initials: D
authors.lastname: Bunjes
authors.forename: Leo F
authors.initials: LF
authors.lastname: Verdonck
authors.forename: Anton
authors.initials: A
authors.lastname: Schattenberg
authors.forename: Hans-Jochem
authors.initials: HJ
authors.lastname: Kolb
authors.forename: Per
authors.initials: P
authors.lastname: Ljungman
authors.forename: Agnes
authors.initials: A
authors.lastname: Devergie
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: Marta
authors.initials: M
authors.lastname: Gomez
authors.forename: Mauricette
authors.initials: M
authors.lastname: Michallet
authors.forename: Ahmet
authors.initials: A
authors.lastname: Elmaagacli
authors.forename: Alois
authors.initials: A
authors.lastname: Gratwohl
authors.forename: Jane
authors.initials: J
authors.lastname: Apperley
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
mesh_terms: D000328:Adult; D001804:Blood Transfusion, Autologous; D005260:Female; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality / Q000628:therapy*; D018655:Lymphocyte Count; D017710:Lymphocyte Transfusion / Q000379:methods* / Q000401:mortality; D008297:Male; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D016896:Treatment Outcome