Summary:Exploiting the graft-versus-leukemia (GVL) effect in mismatched transplants requires its separation from graftversus-host disease (GVHD). We generated leukemiaspecific cytotoxic T lymphocytes (CTL) in three haplotype-mismatched, two class I-mismatched and two single HLA-A locus-matched stimulator-responder pairs. Six patients with chronic myelogenous leukemia and one patient with acute myeloid leukemia transformed from MDS were studied. CTL generated after 10 days stimulation with unselected leukemic peripheral blood mononuclear cells inhibited leukemic CFU-GM colony growth (485% at 10:1 effector:target ratio) with no third-party colony inhibition. In five pairs, responders were cultured separately with leukemia cells, PHA-B or LCL from the stimulator. After 2-4 restimulations, the T cell repertoire was examined by flow analysis using Vb-specific antibodies. Test cultures (but not controls) showed preferential expansion of 1-4 Vb families either common to two or more stimulators or unique to a particular stimulator. Notably, we elicited leukemia-specific TCR Vb expansions on four out of five occasions. In two pairs, responder cells selected for the appropriate leukemia-specific Vb family were shown to have leukemia-specific cytotoxicity. These leukemia-restricted T-cells were CD8+ or CD4+ and CD25+ or CD57+. The results support the development of strategies to selectively deplete GVHD and conserve GVL reactivity in mismatched transplants. Bone Marrow Transplantation (2003) 32, 371-378. doi:10.1038/sj.bmt.1704142Keywords: leukemia-restriction; cytotoxic T-lymphocytes; HLA-mismatched; stem cell transplant The curative effect of allogeneic bone marrow transplantation (allo-BMT) from an HLA-identical donor is well established for a variety of hematological malignancies. Nevertheless, despite the increasing availability of unrelated donors, a suitable HLA-identical donor cannot be identified in a timely fashion for at least 50% of patients.
2,3Animal transplantation models indicate that powerful antitumor cytotoxic T lymphocyte (CTL) can be elicited in an MHC-mismatched setting.4,5 These observations support limited clinical experience in HLA-mismatched transplants indicating a strong graft-versus-leukemia (GVL) effect in high-risk patients with advanced leukemia and in leukemia relapsing after BMT treated with donor lymphocyte infusions.6-9 However, it is also clear that HLA disparity increases the risk of severe graft-versus-host disease (GVHD).10-12 As a result of the risk from GVHD, current HLA-mismatched transplant protocols use T cell depletion and potent immunosuppression to prevent GVHD, which in turn compromises the GVL effect. Separation of GVL alloresponses from the GVHD T cell alloresponse would permit the full exploitation of the therapeutic effect of the haplotype-mismatched transplant. Previous studies in HLA-matched transplants have defined an immunological basis for separating T cell clones with GVHD or GVL alloresponsiveness; while many alloantigens are shared between hematopoietic and nonhe...