Donor leukocyte infusions in 140 patients with relapsed malignancy after allogeneic bone marrow transplantation.

Abstract

DLI results in complete remissions in a high percentage of patients with relapsed chronic-phase CML. Complete remissions are observed less frequently in patients with advanced CML and acute leukemia. GVHD and pancytopenia occur commonly; GVHD is highly correlated with response.

Extramedullary relapse after favorable molecular response to donor leukocyte infusions for recurring acute leukemia

“…Analysis of published results shows that adoptive immunotherapy used alone for treatment of full hematological relapse of acute leukemia leads to 15% (13/84) of complete remission. 7,8,[19][20][21][22][23][24] However, in order to control the disease in acute leukemia relapses, a combination of chemotherapy and immunotherapy is now increasingly used. According to the literature, this strategy allows 55% of disease-free survival (19/34), with a median follow-up of 330 days (range from 40 to 780 days).…”

“…7,8,19,20,[25][26][27][28][29] Such results of donor cell therapy in acute leukemia compared unfavorably with those obtained for cytogenetic or Table 3 FISH studies performed on bone marrow cells from case 3 at various time intervals after DLI and on monoblasts obtained from extramedullary sites, using CEP 8 probe (% of positive cells/500 cells analyzed) hematologic relapse of CML, where complete and durable molecular remission could be induced in 73-76% of cases. 7,8 The difference in the rate of remission induction suggests that CML might represent a more suitable candidate for immunoadoptive therapy, which could be related to the expression of a unique chimeric protein resulting from the chromosomal translocation. 30 In CML, complete cytogenetic responses to DLI were shown to be achieved in a median of 4 months, but molecular remission with the absence of bcr/abl fusion transcripts as determined by RT-PCR may require several months.…”

“…6 Response to donor leukocytes was associated with complete disappearance of the bcr-abl fusion transcript, ensuring sustained remission and long-term survival. 7 In acute leukemia relapse, results from several large analyses indicate that 24-39% of patients may achieve remission after immunoadoptive therapy. [7][8][9][10] Among the complete remitters, the capacity of such a strategy to induce molecular remission is not well-established.…”

“…7 In acute leukemia relapse, results from several large analyses indicate that 24-39% of patients may achieve remission after immunoadoptive therapy. [7][8][9][10] Among the complete remitters, the capacity of such a strategy to induce molecular remission is not well-established. In order to clarify this question, high-risk recurring acute leukemias were analyzed in this study by RT-PCR technology for molecular response to donor cell therapy.…”

Is there still a role for allogeneic stem-cell transplantation in multiple myeloma?

“…[3][4][5]8,9] In initial studies, 50-70% of patients receiving donor lymphocyte infusions for relapsed multiple myeloma have been reported to achieve complete responses. [5,10,11] A more recent survey of 25 patients at 15 centers reported complete responses in only seven patients (28%) who received one or more infusions of donor lymphocytes.[9] In a review of donor lymphocyte infusions for relapsed multiple myeloma, a graft-versus-myeloma effect was noted in 18/22 patients who developed GVHD compared to only 2/7 patients who did not develop GVHD (P = 0.02).[12] These studies suggest that clinical GHVD is not essential for a graft-versus-myeloma effect, but the relationship between the two is very strong. Retrospective studies of reduced-intensity transplants have shown a strong linkage between the development of chronic GVHD and a diminished risk of relapse (HR, 0.37, P = 0.02).…”