Clinical and immunologic outcomes following haplocompatible donor lymphocyte infusions.
We retrospectively analyzed the characteristics of 16 consecutive pediatric patients who received one or more G-CSF-mobilized donor lymphocyte infusions (DLI) following a T-cell-depleted haplocompatible hematopoietic SCT (HSCT) to enhance immune recovery and/or treat an infection. The median time from HSCT to administration of first DLI was 12 weeks and the median dose of DLI administered was 3 x 10(4)/kg (range, 2.5-6 x 10(4)/kg). The incidence of Grade I-II acute GVHD was 19% (95% confidence interval (CI), 6-44%), and there were no cases of Grade III-IV acute GVHD. Chronic GVHD developed in 13% (95% CI, 2-37%) of patients. In surviving patients who did not undergo a second stem cell infusion, T-cell numbers and function increased to a protective level in a median of 3 months (range, 2-12.5 months) following the first DLI administration. In patients given DLI for treatment of an infection, 75% (95% CI, 46-92%) cleared their infection after a median of 9 weeks (range, 1-27 weeks). In patients with CMV infection, the development of CMV-specific T cells was observed following DLI. The 1-year overall survival following haplocompatible DLI was 71% (95% CI, 59-83%), with a median follow-up of 16 months from the first DLI.
Dvorak
C C
CC
UCSF Children's Hospital, University of California, San Francisco, USA. dvorakc@peds.ucsf.edu
Gilman
A L
AL
Horn
B
B
Jaroscak
J
J
Dunn
E A
EA
Baxter-Lowe
L A
LA
Cowan
M J
MJ
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001782:Blood Donors; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000276:immunology / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000097:blood / Q000276:immunology / Q000401:mortality; D006239:Haplotypes; D019337:Hematologic Neoplasms / Q000097:blood / Q000276:immunology / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D017710:Lymphocyte Transfusion; D008297:Male; D020127:Recovery of Function / Q000276:immunology*; D012189:Retrospective Studies; D016511:Severe Combined Immunodeficiency / Q000097:blood / Q000276:immunology / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D013997:Time Factors; D014184:Transplantation, Homologous