Kim J G, Sohn S K, Kim D H, Lee N Y, Suh J S, Lee K S, Lee K B
Department of Hematology/Oncology, Kyungpook National University Hospital, 50 Samduck 2-ka, Jung-ku, Korea.
Bone Marrow Transplant. 2004 Jan;33(2):231-6. doi: 10.1038/sj.bmt.1704328.
Reharvesting leukocytes from donors for a donor leukocyte infusion (DLI) is inconvenient and occasionally impossible in case of unrelated donors. It is well known that the effect of a growth factor-primed DLI is comparable to that of a nonprimed DLI. In total, 42 patients with hematologic malignancies and a high risk of relapse were allocated, on an intent-to-treat basis, a peripheral blood stem cell transplantation (PBSCT) from HLA-matched sibling donors, and then at the time of harvest, additional peripheral blood stem cells (PBSCs) were also reserved for a therapeutic primed DLI in case of relapse. In all, 12 patients who relapsed after allogeneic PBSCT were treated with mainly cytarabine-based chemotherapy followed by a cryopreserved PBSC infusion. The median dose of CD3+ and CD34+ cells for the primed DLIs was 1.43 x 10(8)/kg and 4.75 x 10(6)/kg, respectively. Six of the 12 relapsed patients exhibited a complete response after the primed DLI, plus their 1-year survival rate was 33%. The new development or progression of graft-versus-host disease after a primed DLI was observed in 50% of the patients. Overall, the survival at 1 year was 16.7%. Accordingly, the induction of a graft-versus-leukemia effect through a primed DLI, using additional PBSCs reserved at the original time of harvest, would appear to be feasible for patients with relapsed hematologic malignancies. Furthermore, this approach is also more convenient for donors.
对于供者白细胞输注（DLI）而言，从供者身上再次采集白细胞不方便，对于非血缘供者来说偶尔甚至无法做到。众所周知，生长因子预处理的DLI效果与未预处理的DLI相当。共有42例有高复发风险的血液系统恶性肿瘤患者，按照意向性治疗原则，接受了来自HLA匹配同胞供者的外周血干细胞移植（PBSCT），并且在采集时，还预留了额外的外周血干细胞（PBSC）用于复发时的治疗性预处理DLI。总共有12例异基因PBSCT后复发的患者，主要接受了以阿糖胞苷为基础的化疗，随后进行了冻存的PBSC输注。预处理DLI的CD3+和CD34+细胞的中位剂量分别为1.43×10⁸/kg和4.75×10⁶/kg。12例复发患者中有6例在预处理DLI后出现完全缓解，其1年生存率为33%。50%的患者在预处理DLI后观察到移植物抗宿主病有新的发展或进展。总体而言，1年生存率为16.7%。因此，对于复发的血液系统恶性肿瘤患者，利用在最初采集时预留的额外PBSC通过预处理DLI诱导移植物抗白血病效应似乎是可行的。此外，这种方法对供者来说也更方便。
