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Blood, Vol. 95 No. 1 (January 1), 2000:
pp. 67-71
Comparison of single-dose and escalating-dose regimens of donor
lymphocyte infusion for relapse after allografting for chronic myeloid
leukemia
F. Dazzi,
R. M. Szydlo,
C. Craddock,
N.
C. P. Cross,
J. Kaeda,
A. Chase,
E. Olavarria,
F. van Rhee,
E. Kanfer,
J. F. Apperley, and
J. M. Goldman
From the Department of Haematology, Imperial College School of
Medicine at Hammersmith Hospital, London, United Kingdom.
Donor lymphocyte infusion (DLI) was originally administered as a
single, relatively large dose of lymphocytes called a bulk dose regimen
(BDR). It has since been suggested that the use of an escalating dose
regimen (EDR) may be equally effective against leukemia while it
induces less graft-versus-host disease (GVHD). We therefore compared
the efficacy and incidence of complications in a nonrandomized
sequential study of the 2 regimens in 48 consecutive patients who had
relapses with cytogenetic or hematologic evidence of chronic myeloid
leukemia after allogeneic stem cell transplantation. Twenty-eight patients were treated on a BDR (August 1990 to November 1995) and 20 were treated on an EDR (December 1995 to January 1998).
Although the probability of achieving cytogenetic remission within 2 years of starting DLI did not differ significantly between the 2 groups
(EDR, 91% [CI, 63%-98%] vs. BDR, 67% [CI,49%-83%], P = .70), the incidence of GVHD was much lower using EDR
(10% vs. 44%, P = .011). When we considered only subsets
of patients treated by BDR or EDR who had received comparable total
lymphoid cell doses, the incidence and severity of acute and chronic
GVHD were both significantly lower for recipients treated by EDR than for recipients treated by BDR (P = .005 and
P = .031, respectively). These findings suggest that the
incidence of GVHD associated with the EDR is low, not because the final
cell dose is small, but because lymphocytes are administered over a
considerable number of months. (Blood. 2000;95:67-71)
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