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

• Published in: Bone marrow transplantation (Basingstoke) Vol. 31; no. 8; pp. 687 - 693
• Main Authors: RAIOLA, A. M, VAN LINT, M. T, ROMAGNANI, C, VASSALLO, F, CASINI, M, BRUNO, B, FRASSONI, F, BACIGALUPO, A, VALBONESI, M, LAMPARELLI, T, GUALANDI, F, OCCHINI, D, BREGANTE, S, DI GRAZIA, C, DOMINIETTO, A, SORACCO, M
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.04.2003
• Subjects: Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antigens, CD - blood; Biological and medical sciences; Blast Crisis - therapy; Bone marrow; Bone Marrow Transplantation - immunology; Bone marrow, stem cells transplantation. Graft versus host reaction; CD3 antigen; CD3 Complex - blood; Chemotherapy; Chronic myeloid leukemia; Complications and side effects; Cytogenetics; Female; Graft versus host disease; Graft versus host reaction; Graft vs Host Disease - epidemiology; Histocompatibility antigen HLA; Humans; Immune response; Leukemia; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - pathology; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - therapy; Lymphocyte Transfusion; Lymphocytes; Male; Medical sciences; Middle Aged; Multivariate analysis; Myeloid leukemia; Pancytopenia; Patients; Predictive Value of Tests; Probability; Prognosis; Recurrence; Remission; Retrospective Studies; Risk factors; Serum levels; Stem cell transplantation; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Homologous - adverse effects; Transplants; Tumors; γ-Glutamyltransferase; Human; Immunopathology; Stem cell; relapse post-BMT; Hematopoietic cell; Homograft; Graft versus host reaction; GvHD; Blood; donor lymphocyte infusion; Infusion; Donor; response; Graft; Complication; Predictive factor; Lymphocyte
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1703883

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.