Factors predicting response and graft-versus-host disease after donor lymphocyte infusions: a study on 593 infusions.
In the present study, we analyze factors predicting graft-versus-host disease (GvHD) and response after donor lymphocyte infusions (DLI). A total of 100 patients received 593 DLI between June 1990 and December 2000 in a bulk dose (n=14) or in escalating dose infusions (n=86). Patients were analyzed after stratification for type of relapse: (1). molecular relapse (n=6), (2). cytogenetic relapse (n=20), (3). chronic phase of chronic myeloid leukemia (CML) or complete remission of other disease post chemotherapy (n=24), (4). CML in accelerated/blastic phase (n=14), (5). resistant disease not responding to chemotherapy (n=36). The proportion of responders to DLI in these five groups was 100, 90, 75, 36 and 0% (P<0.0001). Factors predicting response by multivariate analysis were type of relapse (P<0.0001), post-DLI GvHD (P=0.005), pancytopenia (P=0.008), and a diagnosis of CML (P=0.04). Acute GvHD (grades II-IV) occurred in 21 patients (21%), and correlated in multivariate analysis with pancytopenia and less than four DLI. Other predictors of GvHD were the number of CD3+cells/infusion and serum levels of gamma-glutamyl transferase (gammaGT). The actuarial probability of treatment-related mortality was 9% for HLA identical siblings and 44% for alternative donor transplants (P=0.006). Response to DLI is predicted by tumor burden and is associated with GvHD and pancytopenia.
Raiola
A M
AM
Dipartimento di Emato-Oncologia, e Centro Trasfusionale, Ospedale San Martino, Genova, Italy.
Van Lint
M T
MT
Valbonesi
M
M
Lamparelli
T
T
Gualandi
F
F
Occhini
D
D
Bregante
S
S
di Grazia
C
C
Dominietto
A
A
Soracco
M
M
Romagnani
C
C
Vassallo
F
F
Casini
M
M
Bruno
B
B
Frassoni
F
F
Bacigalupo
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D015703:Antigens, CD / Q000097:blood; D001752:Blast Crisis / Q000628:therapy; D016026:Bone Marrow Transplantation / Q000276:immunology*; D017252:CD3 Complex / Q000097:blood; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology*; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000473:pathology / Q000628:therapy*; D017710:Lymphocyte Transfusion; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D014184:Transplantation, Homologous / Q000009:adverse effects
D015703:Antigens, CD; D017252:CD3 Complex