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

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.

• Authors: A M Raiola, M T Van Lint, M Valbonesi, T Lamparelli, F Gualandi, D Occhini, S Bregante, C di Grazia, A Dominietto, M Soracco, C Romagnani, F Vassallo, M Casini, B Bruno, F Frassoni, A Bacigalupo
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 31 Issue 8 Pg. 687-93 (Apr 2003) ISSN: 0268-3369 [Print] England
• PMID: 12692609 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antigens, CD
• CD3 Complex

Topics

• Adolescent
• Adult
• Aged
• Antigens, CD (blood)
• Blast Crisis (therapy)
• Bone Marrow Transplantation (immunology)
• CD3 Complex (blood)
• Female
• Graft vs Host Disease (epidemiology)
• Humans
• Leukemia, Myelogenous, Chronic, BCR-ABL Positive (pathology, therapy)
• Lymphocyte Transfusion
• Male
• Middle Aged
• Predictive Value of Tests
• Probability
• Prognosis
• Recurrence
• Retrospective Studies
• Transplantation, Homologous (adverse effects)