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Factors predicting response and graft-versus-host disease after donor lymphocyte infusions: a study on 593 infusions.

Authors :
Raiola AM
Van Lint MT
Valbonesi M
Lamparelli T
Gualandi F
Occhini D
Bregante S
di Grazia C
Dominietto A
Soracco M
Romagnani C
Vassallo F
Casini M
Bruno B
Frassoni F
Bacigalupo A
Source :
Bone marrow transplantation [Bone Marrow Transplant] 2003 Apr; Vol. 31 (8), pp. 687-93.
Publication Year :
2003

Abstract

In the present study, we analyze factors predicting graft-versus-host disease (GvHD) and response after donor lymphocyte infusions (DLI). A total of 100 patients received 593 DLI between June 1990 and December 2000 in a bulk dose (n=14) or in escalating dose infusions (n=86). Patients were analyzed after stratification for type of relapse: (1). molecular relapse (n=6), (2). cytogenetic relapse (n=20), (3). chronic phase of chronic myeloid leukemia (CML) or complete remission of other disease post chemotherapy (n=24), (4). CML in accelerated/blastic phase (n=14), (5). resistant disease not responding to chemotherapy (n=36). The proportion of responders to DLI in these five groups was 100, 90, 75, 36 and 0% (P<0.0001). Factors predicting response by multivariate analysis were type of relapse (P<0.0001), post-DLI GvHD (P=0.005), pancytopenia (P=0.008), and a diagnosis of CML (P=0.04). Acute GvHD (grades II-IV) occurred in 21 patients (21%), and correlated in multivariate analysis with pancytopenia and less than four DLI. Other predictors of GvHD were the number of CD3+cells/infusion and serum levels of gamma-glutamyl transferase (gammaGT). The actuarial probability of treatment-related mortality was 9% for HLA identical siblings and 44% for alternative donor transplants (P=0.006). Response to DLI is predicted by tumor burden and is associated with GvHD and pancytopenia.

Details

Language :
English
ISSN :
0268-3369
Volume :
31
Issue :
8
Database :
MEDLINE
Journal :
Bone marrow transplantation
Publication Type :
Academic Journal
Accession number :
12692609
Full Text :
https://doi.org/10.1038/sj.bmt.1703883