Santoro Nicole, Mooyaart Jarl E, Devillier Raynier, Koc Yener, Vydra Jan, Castagna Luca, Gülbas Zafer, Martin José Diez, Araujo Mercedes Colorado, Kulagin Alexander, Arat Mutlu, Arroyo Concepcion Herrera, Martelli Maria Paola, Di Ianni Mauro, Hoogenboom Jorinde D, de Wreede Liesbeth C, Ruggeri Annalisa, Chabannon Christian
Department of Hematology and Oncology, Ospedale Civile "Santo Spirito", Pescara, Italy.
EBMT Statistical Unit, Leiden, The Netherlands.
Bone Marrow Transplant. 2023 Jan;58(1):54-60. doi: 10.1038/s41409-022-01839-8. Epub 2022 Oct 10.
Donor lymphocyte infusion (DLI) is a treatment option to prevent or treat relapse after allogeneic hematopoietic cell transplantation (HCT). We here report data for 173 patients who received one or multiple DLIs after haploidentical-HCT with post-transplant cyclophosphamide (PTCY) at 47 EBMT centers from 2009 to 2018. Indication for DLI was: prophylactic for 59 (34.3%), preemptive for 20(11.6%), and therapeutic for 93(54.1%). For the prophylactic group, the median number of DLIs was 1 (IQR:1-2.5) with a median first dose of 0.1 × 10 CD3+ T cell/kg, for the preemptive 2 (IQR:1-3) with 0.5 × 10 CD3+ T cell/kg, for the therapeutic 1 (IQR:1-3) with 1 × 10CD3+ Tcell/kg, respectively. OS after first DLI was 61% (46-75%) for prophylactic, 40% (19-61%) for preemptive, and 22% (13-31%) for therapeutic. CI of II-IV aGVHD and cGVHD was 17% (7-27%) and 53% (40-67%) for the prophylactic, 20% (2-38%) and 21% (3-39%) for the preemptive, 17% (9-24%) and 24% (15-33%) for the therapeutic group, respectively. Our data show great variability in the indications and modalities of DLI across responding EBMT centers. Survival rates remain relatively low in patients with active disease. While the cumulative incidence of aGVHD appears acceptable, we showed a high incidence of cGVHD in the prophylactic group, compared with preemptive and therapeutic DLI. These data should be investigated further in prospective clinical trials.
供体淋巴细胞输注（DLI）是预防或治疗异基因造血细胞移植（HCT）后复发的一种治疗选择。我们在此报告了2009年至2018年期间在47个欧洲血液与骨髓移植协会（EBMT）中心接受单倍体相合HCT并使用移植后环磷酰胺（PTCY）治疗后接受一次或多次DLI的173例患者的数据。DLI的适应证为：预防性59例（34.3%），抢先性20例（11.6%），治疗性93例（54.1%）。预防性组DLI的中位数为1次（四分位间距：1 - 2.5次），首次剂量中位数为0.1×10⁶ CD3⁺ T细胞/kg；抢先性组为2次（四分位间距：1 - 3次），首次剂量为0.5×10⁶ CD3⁺ T细胞/kg；治疗性组为1次（四分位间距：1 - 3次），首次剂量为1×10⁶ CD3⁺ T细胞/kg。首次DLI后的总生存期（OS），预防性组为61%（46% - 75%），抢先性组为40%（19% - 61%），治疗性组为22%（13% - 31%）。Ⅱ - Ⅳ级急性移植物抗宿主病（aGVHD）和慢性移植物抗宿主病（cGVHD）的发生率分别为：预防性组17%（7% - 27%）和53%（40% - 67%），抢先性组20%（2% - 38%）和21%（3% - 39%），治疗性组17%（9% - 24%）和24%（15% - 33%）。我们的数据显示，各有反应的EBMT中心在DLI的适应证和方式上存在很大差异。活动性疾病患者的生存率仍然相对较低。虽然aGVHD的累积发生率似乎可以接受，但与抢先性和治疗性DLI相比，我们发现预防性组cGVHD的发生率较高。这些数据应在前瞻性临床试验中进一步研究。
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