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Blood, 1 February 2004, Vol. 103, No. 3, pp. 790-795.
Prepublished online as a Blood First Edition Paper on October 2, 2003; DOI 10.1182/blood-2003-07-2344.


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Submitted July 11, 2003
Accepted September 22, 2003

Adoptive immunotherapy with donor lymphocyte infusions after allogeneic hematopoietic cell transplantation following nonmyeloablative conditioning

Wolfgang A Bethge, Ute Hegenbart, Monic J Stuart, Barry E Storer, Michael B Maris, Mary E D Flowers, David G Maloney, Thomas Chauncey, Benedetto Bruno, Ed Agura, Stephen J Forman, Karl G Blume, Dietger Niederwieser, Rainer Storb, and Brenda M Sandmaier*

Fred Hutchinson Cancer Research Center, Seattle, WA, USA; University of Washington, Seattle, WA, USA
University of Leipzig, Leipzig, Germany
Stanford University, Stanford, CA, USA
Veterans Administration Medical Center, Seattle, WA, USA
University of Torino, Turin, Italy
Baylor University, Dallas, TX, USA
City of Hope National Medical Center, Duarte, CA, USA

* Corresponding author; email: bsandmai{at}fhcrc.org.

This study retrospectively analyzed data from 446 patients given hematopoietic cell transplantation (HCT) from HLA-matched related or unrelated donors after conditioning with 2 Gy total body irradiation with or without fludarabine and postgrafting immunosuppression with mycophenolate mofetil and cyclosporine. Fifty-three of 446 patients received DLI with a median CD3-dose of 1x107 cells/kg. Their diagnoses included myelodysplastic syndrome (n=10), acute leukemia (n=10), chronic leukemia (n=11), multiple myeloma (n=9), lymphoma (n=9) and solid tumors (n=4). Patients received DLI for persistent disease (n=8), disease relapse (n=17), progressive disease (n=12), low donor chimerism with disease (n=11) or low chimerism with disease remission (n=5). Seventeen of the 53 patients (32%) are alive with a median follow-up of 30 months; five in complete remission (CR), 2 in partial remission (PR) and 10 with stable or progressive disease. Nine of 53 patients (17%) developed grades II-IV acute graft-versus-host disease. Of 48 patients receiving DLI for treatment of disease, 7 achieved CR and 5 PR, with an overall response rate of 25%. Six of 16 patients who received DLI for chimerism had increases in donor chimerism leading to sustained engraftment while 10 eventually rejected their grafts. In conclusion, DLI is a potential treatment strategy for patients with persistent, relapsed or progressive disease after nonmyeloablative HCT with acceptable toxicity.


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