Collins R H, Goldstein S, Giralt S, Levine J, Porter D, Drobyski W, Barrett J, Johnson M, Kirk A, Horowitz M, Parker P
University of Texas Southwestern Medical Center, Dallas 75390-8590, USA.
Bone Marrow Transplant. 2000 Sep;26(5):511-6. doi: 10.1038/sj.bmt.1702555.
Donor leukocyte infusion (DLI) has well-documented activity in CML but the role of DLI in other diseases is less well defined. To evaluate the strategy in acute lymphocytic leukemia (ALL) we evaluated 44 ALL patients from 27 centers who were treated with DLI. Patients with persistent or recurrent disease received DLI from the original marrow donor (30 matched related, four mismatched family, and 10 matched unrelated). Chemotherapy was given before DLI to 28 patients. Of 15 patients who received no pre-DLI chemotherapy, two achieved complete remissions, lasting 1112 and 764+ days. In four patients who received DLI as consolidation of remission induced by chemotherapy or immunosuppression-withdrawal, duration of remission post DLI was 65, 99, 195 and 672+ days. Of 25 patients who received DLI in the nadir after chemotherapy, 13 survived > or =30 days post DLI but did not achieve remission, seven died within less than 30 days post DLI, and five entered remissions that lasted 42, 68, 83, 90, 193 days. Seven patients who did not respond to the initial DLI received a second DLI; none of these patients attained durable remission. Eighteen of 37 evaluable patients developed acute GVHD and five of 20 evaluable patients developed chronic GVHD. Overall actuarial survival is 13% at 3 years. In conclusion, DLI has limited benefit in ALL. New approaches are needed in this group of patients.
供体白细胞输注（DLI）在慢性粒细胞白血病（CML）中的活性已有充分记录，但DLI在其他疾病中的作用尚不太明确。为了评估急性淋巴细胞白血病（ALL）中的这一策略，我们评估了来自27个中心的44例接受DLI治疗的ALL患者。持续性或复发性疾病患者接受来自原始骨髓供体的DLI（30例匹配的亲属供体、4例不匹配的家族供体和10例匹配的无关供体）。28例患者在DLI前接受了化疗。在15例未接受DLI前化疗的患者中，2例实现完全缓解，持续时间分别为1112天和764 +天。在4例接受DLI作为化疗或免疫抑制撤减诱导缓解巩固治疗的患者中，DLI后缓解持续时间分别为65、99、195和672 +天。在25例化疗后最低点接受DLI的患者中，13例在DLI后存活≥30天但未实现缓解，7例在DLI后30天内死亡，5例进入缓解期，持续时间分别为42、68、83、90、193天。7例对初始DLI无反应的患者接受了第二次DLI；这些患者均未获得持久缓解。37例可评估患者中有18例发生急性移植物抗宿主病（GVHD），20例可评估患者中有5例发生慢性GVHD。3年时总体精算生存率为13%。总之，DLI在ALL中的益处有限。这组患者需要新的治疗方法。
