title: HLA-haploidentical donor lymphocyte infusions for patients with relapsed hematologic malignancies after related HLA-haploidentical bone marrow transplantation.
abstract: Treatment of relapse after related HLA-haploidentical T cell-replete bone marrow transplantation (haploBMT) with post-transplantation cyclophosphamide (PTCy) using haploidentical donor lymphocyte infusion (haploDLI) is not documented. All patients who received haploDLI after haploBMT with PTCy between June 2003 and October 2012 were identified and assessed for graft-versus-host disease (GVHD) and outcomes. Forty patients received 52 haploDLI doses. Sixteen patients had acute myeloid leukemia, 11 had lymphomas, and 34 had nonmyeloablative conditioning before haploBMT. The median time from haploBMT to relapse was 183 (range, 0 to 1399) days. The median age at haploDLI was 48 (range, 3 to 70) years. The first haploDLI doses were 1 × 10(5) CD3(+) cells/kg with subsequent escalation. The most commonly used first haploDLI dose was 1 × 10(6) CD3(+) cells/kg. The median follow-up after haploDLI was 7 (mean, 15.4; range, .5 to 96) months for the entire cohort, and 17.5 (mean, 28; range, 2.4 to 96) months for the responders. Acute GVHD developed in 10 patients (25%), 6 patients had grade 3 to 4, and 3 developed chronic GVHD. Twelve (30%) patients achieved a complete response (CR) with a median duration of 11.8 (mean, 22.5; range, .4 to 94) months. At last follow-up, 8 responders were alive in CR; 6 for over a year. HaploDLI for relapse after haploBMT is associated with acceptable toxicities and can result in durable responses.
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Department of Oncology at the Johns Hopkins University, Baltimore, Maryland.
authors.forename: Amer M
authors.initials: AM
authors.lastname: Zeidan
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Department of Oncology at the Johns Hopkins University, Baltimore, Maryland.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Forde
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Department of Oncology at the Johns Hopkins University, Baltimore, Maryland.
authors.forename: Heather
authors.initials: H
authors.lastname: Symons
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Department of Oncology at the Johns Hopkins University, Baltimore, Maryland.
authors.forename: Allen
authors.initials: A
authors.lastname: Chen
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Department of Oncology at the Johns Hopkins University, Baltimore, Maryland.
authors.forename: B Douglas
authors.initials: BD
authors.lastname: Smith
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Department of Oncology at the Johns Hopkins University, Baltimore, Maryland.
authors.forename: Keith
authors.initials: K
authors.lastname: Pratz
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Department of Oncology at the Johns Hopkins University, Baltimore, Maryland.
authors.forename: Hetty
authors.initials: H
authors.lastname: Carraway
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Department of Oncology at the Johns Hopkins University, Baltimore, Maryland.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Gladstone
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Department of Oncology at the Johns Hopkins University, Baltimore, Maryland.
authors.forename: Ephraim J
authors.initials: EJ
authors.lastname: Fuchs
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Department of Oncology at the Johns Hopkins University, Baltimore, Maryland.
authors.forename: Leo
authors.initials: L
authors.lastname: Luznik
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Department of Oncology at the Johns Hopkins University, Baltimore, Maryland.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Jones
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Department of Oncology at the Johns Hopkins University, Baltimore, Maryland. Electronic address: fbolano2@jhmi.edu.
authors.forename: Javier
authors.initials: J
authors.lastname: Bolaños-Meade
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000627:therapeutic use*; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology / Q000473:pathology; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology; D006239:Haplotypes; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D017710:Lymphocyte Transfusion; D008223:Lymphoma / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D016019:Survival Analysis; D013601:T-Lymphocytes / Q000637:transplantation; D019172:Transplantation Conditioning; D014185:Transplantation, Isogeneic
chemical_list: D018906:Antineoplastic Agents, Alkylating; D006680:HLA Antigens; D003520:Cyclophosphamide
keywords: Bone marrow transplantation (BMT); Donor lymphocyte infusion (DLI); Haploidentical; Human leukocyte antigen (HLA); Stem cell transplantation