Vela-Ojeda J, García-Ruiz Esparza M A, Reyes-Maldonado E, Jiménez-Zamudio L, Moreno-Lafont M, García-Latorre E, Ramírez-Sanjuan E, Montiel-Cervantes L, Tripp-Villanueva F, García-León L D, Ayala-Sánchez M, Rosas-Cabral A, Aviña-Zubieta J A, Galindo-Rodríguez G, Vadillo-Buenfil M, Salazar-Exaire D
Hematology Department, Bone Marrow Transplant Unit, Hospital de Especialidades Centro Médico Nacional "La Raza," Instituto Mexicano del Seguro Social, Apartado postal 14-878, C.P. 07001, México D F, México.
Ann Hematol. 2004 May;83(5):295-301. doi: 10.1007/s00277-003-0822-y. Epub 2003 Dec 5.
Between December 1993 and November 2001, 30 patients with chronic myeloid leukemia who relapsed after stem cell transplantation were studied. Seventeen patients were not treated before donor lymphocyte infusion (DLI), eight patients received interferon-alpha (IFN-alpha), and five underwent chemotherapy. The method of DLI was the bulk dose regimen. The median time between DLIs was 6 weeks. The median number of infusions was three; the median time from transplant to relapse was 17 months and from relapse to DLI 2 months. Eleven patients (37%) were in molecular/cytogenetic relapse, 14 (47%) in chronic phase, and five (16%) in accelerated or blastic phase. Seventeen patients (57%) developed acute graft-versus-host disease (GVHD). Chronic GVHD was observed in 15 of 24 (62%) patients. Four (13%) patients developed cytopenia after a median of 30 days. Nineteen (63%) patients achieved response, 15 of them developed GVHD. The response rate according to the disease phase was molecular or cytogenetic relapse: 91%, chronic phase: 57%, and accelerated or blastic phase: 20%. The median time to response was 6 months. Patients treated with IFN-alpha or no treatment as well as those who were in molecular/cytogenetic relapse and those who received a CD3(+) cell dose <1 x 10(8)/kg and CD4(+) <8 x 10(7)/kg had better survival. We conclude that patients who receive lower doses of lymphocytes have better survival. In some patients IFN-alpha seems to be a good choice to potentiate the graft-versus-leukemia (GVL) effect.
1993年12月至2001年11月，对30例干细胞移植后复发的慢性髓性白血病患者进行了研究。17例患者在供体淋巴细胞输注（DLI）前未接受治疗，8例患者接受了α干扰素（IFN-α）治疗，5例接受了化疗。DLI的方法为大剂量方案。DLI之间的中位时间为6周。输注的中位次数为3次；从移植到复发的中位时间为17个月，从复发到DLI的中位时间为2个月。11例患者（37%）处于分子/细胞遗传学复发状态，14例（47%）处于慢性期，5例（16%）处于加速期或急变期。17例患者（57%）发生了急性移植物抗宿主病（GVHD）。24例患者中有15例（62%）观察到慢性GVHD。4例（13%）患者在中位30天后出现血细胞减少。19例（63%）患者获得缓解，其中15例发生了GVHD。根据疾病阶段的缓解率为：分子或细胞遗传学复发：91%，慢性期：57%，加速期或急变期：20%。缓解的中位时间为6个月。接受IFN-α治疗或未治疗的患者，以及处于分子/细胞遗传学复发状态的患者，以及接受CD3(+)细胞剂量<1×10(8)/kg和CD4(+) <8×10(7)/kg的患者生存情况较好。我们得出结论，接受较低剂量淋巴细胞的患者生存情况较好。在一些患者中，IFN-α似乎是增强移植物抗白血病（GVL）效应的一个不错选择。
