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Blood, 15 February 2006, Vol. 107, No. 4, pp. 1325-1331.
Prepublished online as a Blood First Edition Paper on November 3, 2005; DOI 10.1182/blood-2005-08-3373.
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CLINICAL TRIALS AND OBSERVATIONS
A phase 1 trial of donor lymphocyte infusions expanded and activated ex vivo via CD3/CD28 costimulation
David L. Porter,
Bruce L. Levine,
Nancy Bunin,
Edward A. Stadtmauer,
Selina M. Luger,
Steven Goldstein,
Alison Loren,
Julie Phillips,
Sunita Nasta,
Alexander Perl,
Steven Schuster,
Donald Tsai,
Ambika Sohal,
Elizabeth Veloso,
Stephen Emerson, and
Carl H. June
From the Stem Cell Transplant Program, the Hematology-Oncology Division, and Abramson Cancer Center, University of Pennsylvania, Philadelphia; and the Department of Pathology and Laboratory Medicine, Abramson Family Cancer Research Institute; and Division of Oncology, Children's Hospital of Philadelphia, PA.
Donor lymphocyte infusions (DLIs) induce potent graft versus tumor (GVT) effects for relapsed chronic myelogenous leukemia (CML) after allogeneic stem cell transplantation (SCT) but are disappointing for other diseases. Disease resistance can occur if donor T cells are not appropriately activated in vivo. Ex vivo T-cell activation might overcome disease-induced anergy and augment GVT activity. We performed a phase 1 trial of ex vivoactivated DLI (aDLI) for 18 patients with relapse after SCT. Activated donor T cells are produced through costimulation with anti-CD3 and anti-CD28coated beads. Patients with aggressive malignancies received induction chemotherapy, and all patients received conventional DLI (median, 1.5 x 108 mononuclear cells/kg) followed 12 days later by aDLI. Activated DLI was dose escalated from 1 x 106 to 1 x 108 CD3+ cells per kilogram in 5 levels. Seven patients developed acute graft versus host disease (GVHD) (5 grade I-II, 2 grade III), and 4 developed chronic GVHD. Eight patients achieved complete remission, including 4 of 7 with acute lymphocytic leukemia (ALL), 2 of 4 with acute myelogenous leukemia (AML), 1 with chronic lymphocytic leukemia (CLL), and 1 of 2 with non-Hodgkin lymphoma (NHL). Four complete responders relapsed while 4 remain alive in remission a median 23 months after aDLI. Overall, 10 of 18 remain alive 11 to 53 months after aDLI. Adoptive transfer of costimulated activated allogeneic T cells is feasible, does not result in excessive GVHD, and may contribute to durable remissions in diseases where conventional DLI has been disappointing.

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