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Blood, Vol. 95 No. 4 (February 15), 2000:
pp. 1214-1221
Treatment of relapsed leukemia after unrelated donor marrow
transplantation with unrelated donor leukocyte infusions
David L. Porter,
Robert H. Collins Jr,
Christine Hardy,
Nancy A. Kernan,
William R. Drobyski,
Sergio Giralt,
Mary E.D. Flowers,
James Casper,
Ann Leahey,
Pablo Parker,
Rosemarie Mick,
Bev Bate-Boyle,
Roberta King, and
Joseph H. Antin
From the Division of Hematology-Oncology, Department of Medicine,
and from the Department of Epidemiology and Biostatistics, University
of Pennsylvania Medical Center, Philadelphia, PA; Division of
Hematology/Oncology, University of Texas Southwestern Medical School,
and Baylor Sammons Cancer Center-Dallas, Dallas, TX; Memorial Sloan
Kettering Cancer Center, New York, NY; Division of Hematology-Oncology,
Department of Medicine, and from the Division of Pediatrics, Bone
Marrow Transplant Program, Medical College of Wisconsin, Milwaukee, WI;
Department of Hematology, University of Texas MD Anderson Cancer
Center, Houston, TX; Fred Hutchinson Cancer Research Center, University
of Washington, Seattle, WA; Division of Oncology, Children's Hospital
of Philadelphia, Philadelphia, PA; City of Hope Medical Center, Duarte,
CA; National Marrow Donor Program, Minneapolis, MN; and Department of
Adult Oncology, Dana-Farber/Partners Cancer Care and Department of
Medicine, Brigham and Women's Hospital and Harvard Medical School,
Boston, MA.
The efficacy and toxicity of donor leukocyte infusions (DLI) after
unrelated donor bone marrow transplantation (BMT) is largely unknown.
We identified 58 recipients of unrelated DLI (UDLI) for the treatment
of relapsed disease from the National Marrow Donor Program database. A
retrospective analysis was performed to determine response, toxicity,
and survival after UDLI and to identify factors associated with
successful therapy. UDLI was administered for relapsed chronic
myelogenous leukemia (CML) (n = 25), acute myelogenous leukemia
(AML) (n = 23), acute lymphoblastic leukemia (ALL) (n = 7), and
other diseases (n = 3). Eight patients were in complete remission
(CR) before UDLI, and 50 were evaluable for response. Forty-two percent
(95% confidence interval [CI], 28%-56%) achieved CR, including 11 of 24 (46%; 95% CI, 26%-66%) with CML, 8 of 19 (42%; 95% CI,
20%-64%) with AML, and 2 of 4 (50%; 95% CI, 1%-99%) with ALL. The
estimated probability of disease-free survival (DFS) at 1 year after CR
was 65% (95% CI, 50%-79%) for CML, 23% (95% CI, 9%-38%) for
AML, and 30% (95% CI, 6%-54%) for ALL. Acute graft-versus-host disease (GVHD) complicated UDLI in 37% of patients (grade II-IV, 25%). A total of 13 of 32 evaluable patients (41%) developed chronic GVHD. There was no association between cell dose administered and
either response or toxicity. In a multivariable analysis, only a
longer interval from BMT to relapse and BMT to UDLI was associated with improved survival and DFS, respectively. UDLI is an
acceptable alternative to other treatment options for relapse after unrelated donor BMT.
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