Schattenberg A, Schaap N, Van De Wiel-Van Kemenade E, Bär B, Preijers F, Van Der Maazen R, Roovers E, De Witte T
Division of Hematology, University Hospital Nijmegen, The Netherlands.
Leuk Lymphoma. 1999 Jan;32(3-4):317-25. doi: 10.3109/10428199909167392.
Donor leukocyte infusions (DLI) from the original marrow donor have been shown to induce remission in patients with relapse after BMT. We analyzed factors that were associated with remission. Twenty-six patients with a relapse after T cell depleted BMT received DLI. The following pre-DLI factors were analyzed: sex and age of the patients and donors, GVHD after BMT, indication for DLI, percentage of donor T lymphocytes in the patient at the time of DLI, interval between relapse and DLI, and number of T lymphocytes infused. Remission was achieved in 11 of 15 patients (73%) treated for relapsed CML and in one of 11 patients (9%) treated for relapsed AML, ALL or RAEB-t (P = .002). Two of 13 patients (15%) with < or =40% of T lymphocytes from donor origin attained remission compared with 10 of 13 patients (77%) with >40% (P = .002). Two of 13 patients (15%) with an interval of < or =18 months between BMT and first DLI entered remission compared with 10 of 13 patients (77%) with an interval of >18 months (P = .002). Multivariate analysis demonstrated that indication for DLI (CML versus AML/ALL and RAEB-t) and the percentage T lymphocytes from donor origin (< or =40 versus >40) were significantly correlated with remission (P = .03). The occurrence of GVHD post DLI was highly associated with achievement of remission (P = .0001). DLI res ults in remission in a high percentage of patients with relapsed CML after BMT. The percentage of T lymphocytes from donor origin still present in the patient at the time of DLI is highly correlated with achievement of remission.
来自原骨髓供体的供体白细胞输注（DLI）已被证明可使异基因骨髓移植（BMT）后复发的患者获得缓解。我们分析了与缓解相关的因素。26例T细胞去除的BMT后复发的患者接受了DLI。分析了以下DLI前的因素：患者和供体的性别与年龄、BMT后的移植物抗宿主病（GVHD）、DLI的指征、DLI时患者体内供体T淋巴细胞的百分比、复发与DLI之间的间隔以及输注的T淋巴细胞数量。15例接受复发性慢性粒细胞白血病（CML）治疗的患者中有11例（73%）获得缓解，11例接受复发性急性髓系白血病（AML）、急性淋巴细胞白血病（ALL）或难治性贫血伴原始细胞增多-转变型（RAEB-t）治疗的患者中有1例（9%）获得缓解（P = 0.002）。供体来源的T淋巴细胞占比≤40%的13例患者中有2例（15%）获得缓解，而供体来源的T淋巴细胞占比＞40%的13例患者中有10例（77%）获得缓解（P = 0.002）。BMT与首次DLI之间间隔≤18个月的13例患者中有2例（15%）进入缓解期，而间隔＞18个月的13例患者中有10例（77%）进入缓解期（P = 0.002）。多变量分析表明，DLI的指征（CML与AML/ALL和RAEB-t）以及供体来源的T淋巴细胞百分比（≤40%与＞40%）与缓解显著相关（P = 0.03）。DLI后GVHD的发生与缓解的实现高度相关（P = 0.0001）。DLI可使BMT后复发的CML患者中有很高比例获得缓解。DLI时患者体内仍存在的供体来源T淋巴细胞百分比与缓解的实现高度相关。
