Bishop M R, Dean R M, Steinberg S M, Odom J, Pavletic S Z, Chow C, Pittaluga S, Sportes C, Hardy N M, Gea-Banacloche J, Kolstad A, Gress R E, Fowler D H
Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD 20892, USA.
Ann Oncol. 2008 Nov;19(11):1935-40. doi: 10.1093/annonc/mdn404. Epub 2008 Aug 5.
A graft-versus-lymphoma effect against diffuse large B-cell lymphoma (DLBCL) is inferred by sustained relapse-free survival after allogeneic stem-cell transplantation; however, there are limited data on a direct graft-versus-lymphoma effect against DLBCL following immunotherapeutic intervention by either withdrawal of immunosuppression or donor lymphocyte infusion (DLI).
An analysis was carried out to determine whether a direct graft-versus-lymphoma effect exists against DLBCL. The analysis was restricted to patients with DLBCL, who were either not in complete remission at day +100 after allogeneic stem-cell transplantation or subsequently relapsed beyond this time point.
Fifteen patients were identified as either not in complete remission (n = 13) at their day +100 evaluation or subsequently relapsed (n = 2) and were assessed for subsequent responses after withdrawal of immunosuppression or DLI. Eleven patients were treated with either withdrawal of immunosuppression (n = 10) or a DLI (n = 1) alone; four patients received chemotherapy with DLI to reduce tumor bulk. Nine (60%) patients subsequently responded (complete = 8, partial = 1). Six responses occurred after withdrawal of immunosuppression alone. Six patients are alive (range 42-83+ months) in complete remission without further treatment.
The demonstration of sustained complete remission following immunotherapeutic intervention provides direct evidence of a graft-versus-lymphoma effect against DLBCL.
异基因干细胞移植后持续的无复发生存提示存在针对弥漫性大B细胞淋巴瘤（DLBCL）的移植物抗淋巴瘤效应；然而，关于通过停用免疫抑制或供体淋巴细胞输注（DLI）进行免疫治疗干预后针对DLBCL的直接移植物抗淋巴瘤效应的数据有限。
进行一项分析以确定是否存在针对DLBCL的直接移植物抗淋巴瘤效应。该分析仅限于在异基因干细胞移植后第100天未完全缓解或此后复发的DLBCL患者。
15例患者在第100天评估时被确定为未完全缓解（n = 13）或随后复发（n = 2），并在停用免疫抑制或DLI后评估后续反应。11例患者单独接受了停用免疫抑制治疗（n = 10）或DLI治疗（n = 1）；4例患者接受了联合DLI的化疗以缩小肿瘤体积。9例（60%）患者随后出现反应（完全缓解 = 8例，部分缓解 = 1例）。6例反应发生在单独停用免疫抑制后。6例患者在完全缓解状态下存活（范围为42 - 83 +个月），无需进一步治疗。
免疫治疗干预后持续完全缓解的证明为针对DLBCL的移植物抗淋巴瘤效应提供了直接证据。
