Sehn L H, Alyea E P, Weller E, Canning C, Lee S, Ritz J, Antin J H, Soiffer R J
Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA 02115, USA.
J Clin Oncol. 1999 Feb;17(2):561-8. doi: 10.1200/JCO.1999.17.2.561.
Donor lymphocyte infusion (DLI) can restore complete remission in patients with chronic myelogenous leukemia (CML) who have relapsed after T-cell-depleted (TCD) allogeneic bone marrow transplantation (BMT). The existence of salvage treatment for patients with DLI after TCD allogeneic BMT prompted an evaluation of overall outcome after CD6+ -TCD allogeneic BMT for patients treated during the time when DLI has been available.
We performed a retrospective analysis of outcomes of 46 patients who underwent TCD allogeneic BMT for stable-phase CML and compared these outcomes with those of 40 patients who underwent non-TCD allogeneic BMT. All subjects were patients at one of two neighboring institutions during a period when DLI was available. All patients received marrow from HLA-identical sibling donors, underwent similar myeloablative regimens, and had similar pretreatment characteristics.
After BMT, the TCD group had a lower incidence of grade 2 to 4 acute (15% v 37%, P = .026) and chronic graft-versus-host disease (GVHD) (18% v 42%, P = .024) than did the non-TCD group. The 1-year treatment-related mortality rates for the TCD group and the non-TCD group were 13% and 29%, respectively (P = .07). The estimated 3-year probability of relapse (cytogenetic or hematologic) was higher for patients in the TCD group than for patients in the non-TCD group (62% v 24%, P = .0003). Twenty-three patients (20 in the TCD group and three in the non-TCD group) received and were assessable for response to DLI. After DLI, 17 of 20 patients in the TCD group and two of three patients in the non-TCD group achieved complete remission. Donor lymphocyte infusion induced GVHD in nine of 23 patients. Thirty (65%) of 46 patients in the TCD group and 27 (69%) of 39 assessable patients in the non-TCD group remained alive without evidence of disease. The estimated 3-year overall survival rates were similar for the TCD group and the non-TCD group (72% v 68%, respectively; P = .38). At last follow-up, there was no difference in the overall prevalence of GVHD or the proportion of patients requiring immunosuppressive agents between groups.
These results suggest that the combination of T-cell depletion and post-BMT DLI is a viable treatment option for patients undergoing allogeneic BMT for CML and should be prospectively compared with traditional forms of GVHD prophylaxis.
供体淋巴细胞输注（DLI）可使慢性粒细胞白血病（CML）患者在接受去除T细胞（TCD）的异基因骨髓移植（BMT）后复发时恢复完全缓解。TCD异基因BMT后DLI患者挽救治疗的存在促使对在DLI可用期间接受治疗的患者进行CD6 + -TCD异基因BMT后的总体结果进行评估。
我们对46例接受TCD异基因BMT治疗稳定期CML的患者的结果进行了回顾性分析，并将这些结果与40例接受非TCD异基因BMT的患者的结果进行了比较。所有受试者均为在DLI可用期间两个相邻机构之一的患者。所有患者均接受来自HLA相同同胞供体的骨髓，接受相似的清髓方案，且具有相似的预处理特征。
BMT后，TCD组2至4级急性（15%对37%，P = 0.026）和慢性移植物抗宿主病（GVHD）（18%对42%，P = 0.024）的发生率低于非TCD组。TCD组和非TCD组的1年治疗相关死亡率分别为13%和29%（P = 0.07）。TCD组患者的估计3年复发（细胞遗传学或血液学）概率高于非TCD组患者（62%对24%，P = 0.0003）。23例患者（TCD组20例，非TCD组3例）接受了DLI并可评估对DLI的反应。DLI后，TCD组20例患者中的17例和非TCD组3例患者中的2例实现了完全缓解。23例患者中有9例发生了DLI诱导的GVHD。TCD组46例患者中有30例（65%）和非TCD组39例可评估患者中有27例（69%）存活且无疾病证据。TCD组和非TCD组的估计3年总生存率相似（分别为72%对68%；P = 0.38）。在最后一次随访时，两组之间GVHD的总体患病率或需要免疫抑制剂的患者比例没有差异。
这些结果表明，T细胞去除和BMT后DLI的联合是接受CML异基因BMT患者的一种可行治疗选择，应前瞻性地与传统形式的GVHD预防进行比较。
