title: Clinical evidence of a graft-versus-lymphoma effect against relapsed diffuse large B-cell lymphoma after allogeneic hematopoietic stem-cell transplantation.
abstract: BACKGROUND
  A graft-versus-lymphoma effect against diffuse large B-cell lymphoma (DLBCL) is inferred by sustained relapse-free survival after allogeneic stem-cell transplantation; however, there are limited data on a direct graft-versus-lymphoma effect against DLBCL following immunotherapeutic intervention by either withdrawal of immunosuppression or donor lymphocyte infusion (DLI).
  
  
  METHODS
  An analysis was carried out to determine whether a direct graft-versus-lymphoma effect exists against DLBCL. The analysis was restricted to patients with DLBCL, who were either not in complete remission at day +100 after allogeneic stem-cell transplantation or subsequently relapsed beyond this time point.
  
  
  RESULTS
  Fifteen patients were identified as either not in complete remission (n = 13) at their day +100 evaluation or subsequently relapsed (n = 2) and were assessed for subsequent responses after withdrawal of immunosuppression or DLI. Eleven patients were treated with either withdrawal of immunosuppression (n = 10) or a DLI (n = 1) alone; four patients received chemotherapy with DLI to reduce tumor bulk. Nine (60%) patients subsequently responded (complete = 8, partial = 1). Six responses occurred after withdrawal of immunosuppression alone. Six patients are alive (range 42-83+ months) in complete remission without further treatment.
  
  
  CONCLUSIONS
  The demonstration of sustained complete remission following immunotherapeutic intervention provides direct evidence of a graft-versus-lymphoma effect against DLBCL.
authors.affiliation: Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD 20892, USA. mbishop@mail.nih.gov
authors.forename: M R
authors.initials: MR
authors.lastname: Bishop
authors.forename: R M
authors.initials: RM
authors.lastname: Dean
authors.forename: S M
authors.initials: SM
authors.lastname: Steinberg
authors.forename: J
authors.initials: J
authors.lastname: Odom
authors.forename: S Z
authors.initials: SZ
authors.lastname: Pavletic
authors.forename: C
authors.initials: C
authors.lastname: Chow
authors.forename: S
authors.initials: S
authors.lastname: Pittaluga
authors.forename: C
authors.initials: C
authors.lastname: Sportes
authors.forename: N M
authors.initials: NM
authors.lastname: Hardy
authors.forename: J
authors.initials: J
authors.lastname: Gea-Banacloche
authors.forename: A
authors.initials: A
authors.lastname: Kolstad
authors.forename: R E
authors.initials: RE
authors.lastname: Gress
authors.forename: D H
authors.initials: DH
authors.lastname: Fowler
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D020350:Graft vs Tumor Effect / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000276:immunology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged