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Graft-versus-leukemia effect of donor lymphocyte transfusions in marrow
grafted patients. European Group for Blood and Marrow Transplantation
Working Party Chronic Leukemia [see comments]
HJ Kolb, A Schattenberg, JM Goldman, B Hertenstein, N Jacobsen, W Arcese, P Ljungman, A Ferrant, L Verdonck and D Niederwieser
Medizinische Klinik III, Klinikum Grosshadern, Universitaet Muenchen,
Germany.
The immune reactivity of allogeneic lymphocytes plays a major role in the
control of leukemia after bone marrow transplantation. In patients with
recurrent leukemia after marrow transplantation, chimerism and tolerance
provide ideal conditions for adoptive immunotherapy with donor lymphocytes.
We studied the effect of donor lymphocyte transfusions on acute and chronic
leukemia in relapse after bone marrow transplantation. One hundred
thirty-five patients with chronic myeloid leukemia (CML) (N = 84), acute
myeloid leukemia (AML) (N = 23), acute lymphoblastic leukemia (ALL) (N =
22), myelodysplastic syndrome (MDS) (N = 5), and polycythemia vera with
osteomyelofibrosis (PCV) (N = 1) were treated with transfusions of donor
lymphocytes. Patients were monitored for response of leukemia, including in
CML, the use of the polymerase chain reaction for bcr/abl mRNA transcripts
and for the occurrence of graft-versus-host disease (GVHD) and
myelosuppression. Complete remissions were induced by donor lymphocyte
transfusions in 54 patients with CML (73%) and in the patient with PCV;
complete remissions were also induced in five patients (29%) with AML and a
patient with MDS. In contrast, ALL did not respond to adoptive
immunotherapy with donor lymphocyte transfusions. Remissions were durable
in patients treated for CML in chronic phase (probability of remission: 87%
at 3 years). Lymphocyte transfusions were also given to 18 patients with
ALL, AML, MDS, and transformed phase CML who were in remission after
chemotherapy. These remissions were not durable. Fifty- two patients (41%)
developed GVHD of grade 2 or more, and 41 patients (34%) showed signs of
myelosuppression. Seventeen patients died without leukemia, 14 patients
with GVHD and/or myelosuppression. Donor lymphocyte transfusions exert
strong effects against myeloid forms of leukemia and induce durable
remissions in CML.
Volume 86,
Issue 5,
pp. 2041-2050,
09/01/1995
Copyright © 1995 by The American Society of Hematology
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