Bloor Adrian J C, Thomson Kirsty, Chowdhry Noha, Verfuerth Stephanie, Ings Stuart J, Chakraverty Ronjon, Linch David C, Goldstone Anthony H, Peggs Karl S, Mackinnon Stephen
Department of Haematology, Royal Free and University College London School of Medicine, London, United Kingdom.
Biol Blood Marrow Transplant. 2008 Jan;14(1):50-8. doi: 10.1016/j.bbmt.2007.04.013.
The role of donor lymphocyte infusion (DLI) in the management of lymphoid malignancies after allogeneic stem cell transplantation (SCT) has not been clearly characterized. There is emerging evidence pointing to the effectiveness of this approach, particularly in patients with low-grade disease, although to date this has been reported only in small numbers of patients, and thus the utility of this treatment remains uncertain. A total of 28 patients with low-grade lymphoid malignancies previously treated with allogeneic SCT received a total of 68 infusions of donor lymphocytes. The diagnoses were indolent non-Hodgkin lymphoma (NHL; n = 23) and transformed NHL (n = 5), and the indications for DLI were progressive disease with or without mixed chimerism (MC) (n = 17) and persistent MC alone (n = 11). Escalating doses of cells were administered in the absence of graft-versus-host disease (GVHD) or continued disease progression, until stable full donor chimerism or disease response were achieved. The cumulative response rates after DLI to treat progressive disease and persistent MC were 76.5% and 91.6%, respectively. The major toxicity resulting from the use of donor lymphocytes was GVHD. The cumulative incidence of acute grade II-IV disease was 15%, and that of extensive chronic disease was 31%; there were no deaths resulting from GVHD. Seven patients had graft-versus-lymphoma responses without significant GVHD. These data support the existence of a clinically significant graft-versus-tumor effect in indolent NHL and suggest that this is an effective treatment for progressive disease after allogeneic SCT.
供体淋巴细胞输注（DLI）在异基因干细胞移植（SCT）后淋巴恶性肿瘤管理中的作用尚未得到明确界定。越来越多的证据表明这种方法是有效的，特别是对于低度疾病患者，尽管迄今为止仅在少数患者中报道过，因此这种治疗方法的实用性仍不确定。共有28例先前接受过异基因SCT治疗的低度淋巴恶性肿瘤患者接受了总共68次供体淋巴细胞输注。诊断为惰性非霍奇金淋巴瘤（NHL；n = 23）和转化型NHL（n = 5），DLI的指征为伴有或不伴有混合嵌合体（MC）的进展性疾病（n = 17）和单独持续性MC（n = 11）。在没有移植物抗宿主病（GVHD）或疾病持续进展的情况下给予递增剂量的细胞，直到实现稳定的完全供体嵌合体或疾病缓解。DLI治疗进展性疾病和持续性MC后的累积缓解率分别为76.5%和91.6%。使用供体淋巴细胞导致的主要毒性是GVHD。急性II-IV级疾病的累积发生率为15%，广泛慢性疾病的累积发生率为31%；没有因GVHD导致的死亡。7例患者有移植物抗淋巴瘤反应但无明显GVHD。这些数据支持在惰性NHL中存在临床上显著的移植物抗肿瘤效应，并表明这是异基因SCT后进展性疾病的有效治疗方法。
