title: Successful remission rates and survival after lymphodepleting chemotherapy and donor lymphocyte infusion for relapsed hematologic malignancies postallogeneic hematopoietic cell transplantation.
abstract: Few therapeutic strategies exist for hematologic malignancies relapsing post allogeneic hematopoietic cell transplantation. We present outcomes on 35 patients with nonchronic myelogenous leukemia (CML) hematologic malignancies, the majority having acute myelogenous leukemia (AML) or myelodysplastic syndromes/myeloproliferative disorders (MDS/MPD) (n = 22) receiving lymphodepleting chemotherapy followed by donor lymphocyte infusion (DLI) at 2 T cell dose levels (0.5 and 1.0 × 10(8) CD3/kg). Forty-nine percent of patients achieved complete remission (CR), with a median duration of remission of 6 months (range: 2-71+). CR rates were similar between the 2 groups. The incidence of acute graft-versus-host disease (aGVHD) of any grade was 49%. We saw a higher incidence of grade II-IV aGVHD, with a rate of 66% using the higher-dose DLI (grade III, 33% and grade 4, 20%) versus only 25% (10% grade III-IV) with the lower-dose DLI (P = .06). Overall survival at 1 and 2 years was 30% (95% confidence interval [CI], 16%-45%) and 19% (95% CI, 8%-34%); however, for those achieving CR, 1- and 2-year survival was improved at 44% (95% CI, 20%-66%) and 28% (95% CI, 8%-52%) (P = .03), respectively. These results demonstrate that DLI after lymphodepleting chemotherapy for relapsed hematologic malignancies results in frequent CRs. The lower DLI dose regimen improved the tolerability of this therapeutic approach, with modest rates of severe aGVHD.
authors.affiliation: Bone Marrow Transplantation Program, University of Minnesota Medical Center, Minneapolis, Minnesota 55455, USA. ewarlick@umn.edu
authors.forename: Erica D
authors.initials: ED
authors.lastname: Warlick
authors.forename: Todd
authors.initials: T
authors.lastname: DeFor
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Blazar
authors.forename: Linda
authors.initials: L
authors.lastname: Burns
authors.forename: Michael R
authors.initials: MR
authors.lastname: Verneris
authors.forename: Celalettin
authors.initials: C
authors.lastname: Ustun
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D019337:Hematologic Neoplasms / Q000097:blood / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007223:Infant; D008212:Lymphocyte Depletion; D017710:Lymphocyte Transfusion / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012075:Remission, Spontaneous; D016019:Survival Analysis; D055815:Young Adult