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Shah NA. Donor lymphocyte infusion in Acute Myeloid Leukemia. Best Pract Res Clin Haematol 2023; 36:101484. [PMID: 37612002 DOI: 10.1016/j.beha.2023.101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 08/25/2023]
Abstract
Donor lymphocyte infusion (DLI) is an important treatment modality in the management of relapsed hematological malignancies after allogeneic hematopoietic cell transplantation (allo-HCT). Donor T lymphocytes can be used in a therapeutic, pre-emptive or prophylactic manner in an attempt to stimulate a graft versus leukemia (GVL) effect and eradicate residual disease or even prevent relapse in a high-risk setting. DLIs are not without complications, however, graft versus host disease (GVHD) in particular. Data to date is limited to retrospective and small prospective studies. This review summarizes the available literature on approaches to managing relapse, dosing and timing of DLI, complications and potential future therapies.
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Ali T, Behfar M, Mohseni R, Salajegheh P, Kheder M, Abou-Fakher F, Nikfetrat Z, Jafari F, Naji P, Hamidieh AA. Escalated Dose Donor Lymphocyte Infusion Treatment in Patients with Primary Immune Deficiencies After HSCT with Reduced-Intensity Conditioning Regimen. Hematol Oncol Stem Cell Ther 2022; 15:272-278. [PMID: 34242597 DOI: 10.1016/j.hemonc.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 06/06/2021] [Accepted: 06/13/2021] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE/BACKGROUND Mixed chimerism is a major concern after allogenic hematopoietic stem cell transplantation (HSCT) using a reduced-intensity conditioning (RIC) regimen in primary immunodeficiencies (PIDs). A donor lymphocyte infusion (DLI) escalating dose regimen has been developed with the aim of reducing toxicity while preserving efficacy. However, the graft-versus-host disease (GvHD) development remains the most common and adverse effect of DLI and continues to be a limiting factor in its application, especially nonmalignant diseases such as PIDs. We prospectively evaluated PID patients after HSCT using RIC in Childrens Medical Center, who were candidates for an escalating dose of DLI for MC from 2016 to 2018. METHODS With the median follow-up of 16.4 months, 12 patients (nine males and three females) with a median age of 3.72 years received DLI. The median number of DLI was 3.2 (range, 1-5), the maximum and total dose of DLIs administered per patient were 3.6 × 107 (range, 1-5) cells/kg CD3+ and 9.3 × 107 (range, 1-15) cells/kg CD3+ cells, respectively. RESULTS Median donor chimerism at baseline before the DLIs was 41% (range, 11-73%), patients received DLIs at a median of 105 (range, 37-230) days and 52 (range, 3-168) days after the HSCT and onset of the MC, respectively. At the final assessment, six (54.5%) patients improved after DLIs at a median of 47.3 days. CONCLUSION PID patients may benefit from DLI with an escalating dose regimen, but the GvHD development remains a concern during the DLI, and the optimum dose and frequency must be standardized.
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Affiliation(s)
- Tahani Ali
- Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Pediatric Hematopoietic Stem Cell Transplant Center, Children's Hospital, Damascus University, Damascus, Syria
| | - Maryam Behfar
- Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Pediatric Hematopoietic Stem Cell Transplant Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Rashin Mohseni
- Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pourya Salajegheh
- Department of Pediatric, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Maged Kheder
- Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Pediatric Hematopoietic Stem Cell Transplant Center, Children's Hospital, Damascus University, Damascus, Syria
| | - Faihaa Abou-Fakher
- Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Pediatric Hematopoietic Stem Cell Transplant Center, Children's Hospital, Damascus University, Damascus, Syria
| | - Zeynab Nikfetrat
- Pediatric Hematopoietic Stem Cell Transplant Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Jafari
- Pediatric Hematopoietic Stem Cell Transplant Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Naji
- Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ali Hamidieh
- Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Ortí G, Palacio-Garcia C, García-Cadenas I, Sánchez-Ortega I, Jimenez MJ, Azqueta C, Villacampa G, Ferrà C, Parody R, Martino R, Bosch F, Querol S, Valcárcel D. Analysis of Cell Subsets in Donor Lymphocyte Infusions from HLA Identical Sibling Donors after Allogeneic Hematopoietic Cell Transplant. Transplant Cell Ther 2020; 27:53.e1-53.e8. [PMID: 32987150 DOI: 10.1016/j.bbmt.2020.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022]
Abstract
Donor lymphocytes infusions (DLIs) are a major therapeutic approach to treat relapse and mixed chimerism after allogeneic hematopoietic cell transplant (alloHCT). The impact of the composition regarding different cell subsets in the development of graft-versus-host disease (GVHD) is not fully understood. We performed a cell subsets analysis of 56 DLIs from fully HLA-compatible identical matched sibling donors (MSDs) in 36 alloHCT patients and studied its association with GVHD. A median of one DLI was infused per patient. Fourteen patients (38%) developed GVHD. The cell composition analysis of the first DLI (DLI1) showed that a high dose of B cells (P = .03) and CD27+ B cells (P < .01) was associated with GVHD. We identified DLI dose cutoff points for several cell populations above which GVHD was more frequent (CD8+ TN >3 × 106 cells/kg, CD27+ B cells >2.6 × 106/kg, CD27+ NK >0.35 × 106 cells/kg, and mononuclear cells >0.83 × 108/kg). Noteworthy, the proportion of CD4+ naive T cells (TN) or unselected TN was not linked with GVHD and a DLI1 containing a higher dose of regulatory T cells was not protective for GVHD. We studied several transplant clinical variables and did not find any association with GVHD. Altogether, this study provides a comprehensive analysis of the cell populations in a DLI from MSDs and identifies potential key cell subsets, which provides insight for the understanding of GVHD after DLI.
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Affiliation(s)
- Guillermo Ortí
- Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain; Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Carles Palacio-Garcia
- Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Irene García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Sánchez-Ortega
- Hematology Department, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - María José Jimenez
- Hematology Department, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Barcelona, Spain
| | - Carmen Azqueta
- Cellular Therapy Unit, Banc de Sang i Teixits, Barcelona, Spain
| | - Guillermo Villacampa
- Oncology Data Science (ODysSey) Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain
| | - Christelle Ferrà
- Hematology Department, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Barcelona, Spain
| | - Rocio Parody
- Hematology Department, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Bosch
- Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sergi Querol
- Cellular Therapy Unit, Banc de Sang i Teixits, Barcelona, Spain
| | - David Valcárcel
- Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Barcelona, Spain
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Poonsombudlert K, Kewcharoen J, Prueksapraopong C, Limpruttidham N. Prophylactic donor lymphocyte infusion for relapse prevention: a meta-analysis. Jpn J Clin Oncol 2020; 50:661-670. [PMID: 32100001 DOI: 10.1093/jjco/hyaa022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Primary disease relapse (PDR) of malignant hematologic conditions after standard hematopoietic stem cell transplant (HSCT) is one of the most challenging diseases; therefore ongoing researches are aiming at relapse prevention and minimizing the transplant-related side effects. Prophylactic donor lymphocytes (pDLI) had been proposed as a valuable strategy for PDR prevention, but early studies had been discouraging due to the limited benefit and possible association with acute graft-versus-host disease (aGVHD). Therefore, we conducted a meta-analysis to evaluate the association between pDLI use, PDR, aGVHD and OS. METHOD We performed a comprehensive literature search in MEDLINE, Cochrane library and Embase database from inception to May 2019 for studies that evaluated the association between pDLI and PDR. We conducted a random effect meta-analysis of 9 studies involving a total of 748 participants (pDLI = 398, non-pDLI = 350) and reported the pooled odd ratio (OR) for association of pDLI use, PDR, aGVHD and OS. RESULT We found a significant decreased odd of PDR in the pDLI group (pooled OR = 0.42, 95% CI 0.30-0.58, I2 = 0%), but there was no significant increased odd of aGVHD (pooled OR of 0.98, 95% CI 0.56-1.72, I2 = 0.8%). We also found that there was an increased odd of overall survival (OS) (pooled OR 3.17, 95% CI 1.85-5.45, I2 = 50.2%). CONCLUSION There are significantly decreased odd of PDR and increased odd of OS in the pDLI group compared to the control group, but there is no statistically significant increased odd of aGVHD as suggested by previous studies. We concluded that pDLI is a potentially valuable method for post-transplant PDR prevention.
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Affiliation(s)
| | - Jakrin Kewcharoen
- University of Hawaii, Internal Medicine Residency Program, Honolulu, HI, USA, and
| | | | - Nath Limpruttidham
- University of Hawaii, Internal Medicine Residency Program, Honolulu, HI, USA, and
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Abstract
Clinical bone marrow transplantation started in 1957 at a time when remarkably little was known about hematopoietic stems cells, immune responses to transplants or the identity of transplant antigens. This review will delineate the substantial increase in knowledge about these three areas gained between then and 1992 when the Ceppellini School course on Bone Marrow Transplantation was held, along with the progress made in clinical application, as well as the stumbling blocks that remained to be overcome by further research to advance knowledge. It will outline the significant progress made between 1992 and the present year, 2019, and the remaining problems.
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Affiliation(s)
- Elizabeth Simpson
- Division of Immunology & Inflammation, Department of Medicine, Imperial College London, London, United Kingdom
| | - Francesco Dazzi
- Division of Cancer Studies, King's College London, London, United Kingdom
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Donor lymphocyte infusions for B-cell malignancies relapse after T-cell replete allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2018; 54:1133-1137. [PMID: 30546069 DOI: 10.1038/s41409-018-0422-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 11/08/2022]
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Mo XD, Lv M, Huang XJ. Preventing relapse after haematopoietic stem cell transplantation for acute leukaemia: the role of post-transplantation minimal residual disease (MRD) monitoring and MRD-directed intervention. Br J Haematol 2017; 179:184-197. [PMID: 28542711 DOI: 10.1111/bjh.14778] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Xiao-Dong Mo
- Peking University People's Hospital; Peking University Institute of Haematology; Beijing Key Laboratory of Haematopoietic Stem Cell Transplantation; Beijing China
| | - Meng Lv
- Peking University People's Hospital; Peking University Institute of Haematology; Beijing Key Laboratory of Haematopoietic Stem Cell Transplantation; Beijing China
| | - Xiao-Jun Huang
- Peking University People's Hospital; Peking University Institute of Haematology; Beijing Key Laboratory of Haematopoietic Stem Cell Transplantation; Beijing China
- Peking-Tsinghua Centre for Life Sciences; Beijing China
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8
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de Fontbrune FS, Cavalieri D, Leclerc M, Beckerich F, Maury S, de Latour RP, N-Guyen S, Bay JO. Immunothérapie et greffe de cellules souches hématopoïétiques allogéniques. Bull Cancer 2017; 103 Suppl 1:S164-S174. [PMID: 28057181 DOI: 10.1016/s0007-4551(16)30375-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
IMMUNOTHERAPY AND ALLOGENEIC STEM CELLS TRANSPLANTATION Allogeneic stem cell transplantations represent perfect example of immunotherapy. Its positive aspects are due to the graft versus tumor effect. Unfortunately, this therapeutic advantage is usually associated with graft versus host effects. While the mechanism of these two graft reactions remain unclear, this is possible to modulate these immunologic effects. The type of conditioning regimen, the source of donor and the use of donor cells after the transplantation may influence the toxicity and the tumor response, leading to a better optimization of the procedure. This paper is presenting all the parameters which may contribute to improve allogeneic stem cell transplantations.
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Affiliation(s)
| | - Doriane Cavalieri
- Service de thérapie cellulaire et d'hématologie clinique adulte, CHU Clermont-Ferrand, site Estaing, 1, place Lucie-Aubrac, 63000 Clermont-Ferrand, France
| | - Mathieu Leclerc
- Service d'hématologie, greffe de moelle, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris Cedex 10, France
| | - Florence Beckerich
- Service d'hématologie, greffe de moelle, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris Cedex 10, France
| | - Sébastien Maury
- Service d'hématologie, greffe de moelle, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris Cedex 10, France
| | | | - Stéphanie N-Guyen
- Service d'hématologie clinique, hôpital de la Pitié-Salpêtrière (AP-HP) ; Centre d'immunologie et des maladies infectieuses (CIMI-Paris), université Sorbonne, UPMC, université Paris 06, INSERM U1135, CNRS ERL8255, Paris, France
| | - Jacques-Olivier Bay
- Service de thérapie cellulaire et d'hématologie clinique adulte, CHU Clermont-Ferrand, site Estaing, 1, place Lucie-Aubrac, 63000 Clermont-Ferrand, France.
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Lucarelli B, Merli P, Bertaina V, Locatelli F. Strategies to accelerate immune recovery after allogeneic hematopoietic stem cell transplantation. Expert Rev Clin Immunol 2015; 12:343-58. [PMID: 26588325 DOI: 10.1586/1744666x.2016.1123091] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The interplay existing between immune reconstitution and patient outcome has been extensively demonstrated in allogeneic hematopoietic stem cell transplantation. One of the leading causes of infection-related mortality is the slow recovery of T-cell immunity due to the conditioning regimen and/or age-related thymus damage, poor naïve T-cell output, and restricted T-cell receptor (TCR) repertoires. With the aim of improving posttransplantation immune reconstitution, several immunotherapy approaches have been explored. Donor leukocyte infusions are widely used to accelerate immune recovery, but they carry the risk of provoking graft-versus-host disease. This review will focus on sophisticated strategies of thymus function-recovery, adoptive infusion of donor-derived, allodepleted T cells, T-cell lines/clones specific for life-threatening pathogens, regulatory T cells, and of T cells transduced with suicide genes.
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Affiliation(s)
- Barbarella Lucarelli
- a Department of Pediatric Hematology-Oncology , IRCCS, Bambino Gesù Children's Hospital , Rome , Italy
| | - Pietro Merli
- a Department of Pediatric Hematology-Oncology , IRCCS, Bambino Gesù Children's Hospital , Rome , Italy
| | - Valentina Bertaina
- a Department of Pediatric Hematology-Oncology , IRCCS, Bambino Gesù Children's Hospital , Rome , Italy
| | - Franco Locatelli
- a Department of Pediatric Hematology-Oncology , IRCCS, Bambino Gesù Children's Hospital , Rome , Italy.,b Department of Pediatrics , University of Pavia , Pavia , Italy
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10
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Lucarelli B, Merli P, Strocchio L, Cefalo MG, Brescia LP, Locatelli F. T Cell Immunotherapy for Immune Reconstitution and GVHD Prevention After Allogeneic Hematopoietic Stem Cell Transplantation. CURRENT STEM CELL REPORTS 2015. [DOI: 10.1007/s40778-015-0027-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Zhao XS, Wang Y, Yan CH, Wang JZ, Zhang XH, Xu LP, Liu KY, Huang XJ. The cell composition of infused donor lymphocyte has different impact in different types of allogeneic hematopoietic stem cell transplantation. Clin Transplant 2014; 28:926-34. [PMID: 24931494 DOI: 10.1111/ctr.12404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2014] [Indexed: 11/28/2022]
Abstract
Donor lymphocyte infusion (DLI) is often used to enhance the graft-versus-leukemia (GVL) effect after allogeneic hematopoietic stem cell transplantation (allo-HSCT). In this study, we first evaluated the impact of the cell composition of a modified DLI (mDLI) on the prognoses of patients. A total of 194 patients undergoing allo-HSCT were enrolled and received mDLI for various clinical reasons. The infused cellular components of the mDLI were examined by flow cytometry. The results showed that infusion with a lower dose of CD14(+) cells (<0.33 × 10(8) /kg) was an independent risk factor for the occurrence of II-IV acute graft-versus-host disease (aGVHD) (HR = 0.104, p = 0.032) in human leukoctye antigen-identical transplant patients. In addition, a dose of CD14(+) cells greater than the 50th percentile was associated with a lower incidence of hematological relapse and longer disease-free survival (DFS) after the mDLI (relapse: HR = 0.193, p = 0.007; DFS: HR = 0.259, p = 0.016). However, we also found that a greater number of CD14(+) cells were an independent risk factor for II-IV aGVHD (HR = 1.758, p = 0.034) in haploidentical allo-HSCT. In conclusion, our data were the first to demonstrate that the cell composition of a 56 mDLI played a distinct role in different types of allo-HSCT. This finding provided a novel approach for the development of cellular therapies by manipulating the components of infused cells.
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Affiliation(s)
- Xiao-Su Zhao
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
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12
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Klyuchnikov E, Holler E, Bornhäuser M, Kobbe G, Nagler A, Shimoni A, Könecke C, Wolschke C, Bacher U, Zander AR, Kröger N. Donor lymphocyte infusions and second transplantation as salvage treatment for relapsed myelofibrosis after reduced-intensity allografting. Br J Haematol 2012; 159:172-81. [PMID: 22909192 DOI: 10.1111/bjh.12013] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 06/29/2012] [Indexed: 11/29/2022]
Abstract
Thirty myelofibrosis patients (21 males, nine females) with relapse (n = 27) or graft-rejection (n = 3) after dose-reduced allografting underwent a salvage strategy including donor lymphocyte infusions (DLIs) and/or second allogeneic haematopoietic stem cell transplantation (HSCT). Twenty-six patients received a median number of three (range, 1-5) DLIs in a dose-escalated mode starting with a median dose of 1·2 × 10(6) (range, 0·003-8 × 10(6) ) up to median dose of 40 × 10(6) T-cells/kg (range, 10-130 × 10(6) ). 10/26 patients (39%) achieved complete response (CR) to DLIs. Acute (grade II-IV) and chronic graft-versus-host (GvHD) disease occurred in 12% and 36% cases. Thirteen non-responders to DLI and four patients who did not receive DLI due to graft-rejection or acute transformation of the blast phase underwent a second allogeneic HSCT from alternative (n = 15) or the same (n = 2) donor. One patient (6%) experienced primary graft-failure and died. Acute (II-IV) and chronic GvHD were observed in 47% and 46% of patients. Overall responses after second HSCT were seen in 12/15 patients (80%: CR: n = 9, partial response: n = 3). The 1-year cumulative incidence of non-relapse mortality for recipients of a second allograft was 6%, and the cumulative incidence of relapse was 24%. After a median follow-up of 27 months, the 2-year overall survival and progression-free survival for all 30 patients was 70% and 67%, respectively. In conclusion, our two-step strategy, including DLI and second HSCT for non-responding or ineligible patients, is an effective and well-tolerated salvage approach for patients relapsing after reduced-intensity allograft after myelofibrosis.
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Affiliation(s)
- Evgeny Klyuchnikov
- Department of Stem Cell Transplantation, University Cancer Centre Hamburg, Hamburg, Germany
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13
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Abbi KKS, Zhu J, Ehmann WC, Epner E, Carraher M, Mierski J, Talamo G, Lucas K, Rybka W, Claxton D. G-CSF mobilized vs conventional donor lymphocytes for therapy of relapse or incomplete engraftment after allogeneic hematopoietic transplantation. Bone Marrow Transplant 2012; 48:357-62. [DOI: 10.1038/bmt.2012.144] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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14
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Petrovic A, Hale G. Clinical options after failure of allogeneic hematopoietic stem cell transplantation in patients with hematologic malignancies. Expert Rev Clin Immunol 2011; 7:515-25; quiz 526-7. [PMID: 21787195 DOI: 10.1586/eci.11.24] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Disease recurrence is the single most common cause of death after allogeneic or autologous hematopoietic stem cell transplantation (HSCT). Disease status and chemosensitivity at the time of transplantation, as well as the development of graft-versus-host disease (GVHD), are factors known to influence the risk of relapse post-HSCT. Both acute and chronic GVHD have been associated with decreased relapse rates; however, owing to toxicity, overall survival is not consistently improved in these patients. Furthermore, there is a transient period of immunodeficiency after HSCT, which may permit residual malignant cells to proliferate early in the post-transplant course, before the donor immune system can establish a graft-versus-tumor response. Patients who fail an initial HSCT have an extremely poor outcome; therefore, maneuvers to prevent, identify and treat recurrent disease as early as possible in these situations are necessary. Strategies to distinguish graft-versus-tumor from GVHD, to enhance both general and disease-specific immune reconstitution after transplantation, and to increase donor-mediated anti-host immune reactions are being investigated in clinical trials. Single agent nontoxic post-HSCT chemotherapy, cellular therapies and second allogeneic HSCT using reduced intensity regimens are among the modalities under investigation.
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Affiliation(s)
- Aleksandra Petrovic
- Division of Hematology, Oncology, Blood & Marrow Transplantation, All Children's Hospital, 601 5th Street South, St. Petersburg, FL 33701, USA
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Atimere N, Zriba S, Hicheri Y, Pautas C, Cordonnier C, Maury S. Clofarabine as a potential stimulant of alloreactivity. Bone Marrow Transplant 2010; 46:1393-4. [PMID: 21151182 DOI: 10.1038/bmt.2010.309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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16
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Maury S, Lemoine FM, Hicheri Y, Rosenzwajg M, Badoual C, Cheraï M, Beaumont JL, Azar N, Dhedin N, Sirvent A, Buzyn A, Rubio MT, Vigouroux S, Montagne O, Bories D, Roudot-Thoraval F, Vernant JP, Cordonnier C, Klatzmann D, Cohen JL. CD4+CD25+ regulatory T cell depletion improves the graft-versus-tumor effect of donor lymphocytes after allogeneic hematopoietic stem cell transplantation. Sci Transl Med 2010; 2:41ra52. [PMID: 20650872 DOI: 10.1126/scitranslmed.3001302] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Donor T cells play a pivotal role in the graft-versus-tumor effect after allogeneic hematopoietic stem cell transplantation. Regulatory T cells (T(reg)s) may reduce alloreactivity, the major component of the graft-versus-tumor effect. In the setting of donor lymphocyte infusion after hematopoietic stem cell transplantation, we postulated that T(reg) depletion could improve alloreactivity and likewise the graft-versus-tumor effect of donor T cells. The safety and efficacy of T(reg)-depleted donor lymphocyte infusion was studied in 17 adult patients with malignancy relapse after hematopoietic stem cell transplantation. All but one had previously failed to respond to at least one standard donor lymphocyte infusion, and none had experienced graft-versus-host disease. Two of the 17 patients developed graft-versus-host disease after their first T(reg)-depleted donor lymphocyte infusion and experienced a long-term remission of their malignancy. Four of the 15 patients who did not respond after a first T(reg)-depleted donor lymphocyte infusion received a second T(reg)-depleted donor lymphocyte infusion combined with lymphodepleting chemotherapy aimed to also eliminate recipient T(reg)s. All four developed acute-like graft-versus-host disease that was associated with a partial or complete and durable remission. In the whole cohort, graft-versus-host disease induction through T(reg) depletion was associated with improved survival. These results suggest that T(reg)-depleted donor lymphocyte infusion is a safe, feasible approach that induces graft-versus-host or graft-versus-tumor effects in alloreactivity-resistant patients. In patients not responding to this approach, the combination of chemotherapy-induced lymphodepletion of the recipient synergizes with the effect of T(reg)-depleted donor lymphocyte infusion. These findings offer a rational therapeutic approach for cancer cellular immunotherapy.
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Affiliation(s)
- Sébastien Maury
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil F-94010, France.
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Yegin ZA, Ozkurt ZN, Aki SZ, Sucak GT. Donor lymphocyte infusion for leukemia relapse after hematopoietic stem cell transplantation. Transfus Apher Sci 2010; 42:239-45. [PMID: 20385512 DOI: 10.1016/j.transci.2010.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2009] [Indexed: 10/19/2022]
Abstract
Leukemia relapse is a serious therapeutic challenge following hematopoietic stem cell transplantation (HSCT). In this retrospective study, 23 patients [15 (65.2%) AML, 8 (34.8%) ALL] who received DLI+/-reinduction chemotherapy for post-transplant relapse were reviewed. The overall response rate of DLI was 66.7% for AML and 50% for ALL. A total of 15 patients (65.2%) developed acute graft versus host disease (GVHD). Response rates were higher in patients with GVHD (80% versus 25%; p=0.01; OR: 12.0). The probability of OS was better in patients who respond to DLI (p=0.04). Further strategies are required to improve the anti-tumor properties of alloreactive donor lymphocytes and to obtain durable responses with DLI in patients with relapsed acute leukemia after allogeneic HSCT.
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Affiliation(s)
- Zeynep Arzu Yegin
- Gazi University, Faculty of Medicine, Department of Hematology, Ankara, Turkey.
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Donor regulatory T cells identified by FoxP3 expression but also by the membranous CD4+CD127low/neg phenotype influence graft-versus-tumor effect after donor lymphocyte infusion. J Immunother 2009; 31:806-11. [PMID: 18833007 DOI: 10.1097/cji.0b013e318184908d] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Regulatory T cells (Treg) play a pivotal role in the control of graft-versus-host disease (GVHD) and might also influence the graft-versus-tumor effect after allogeneic stem cell transplantation. We assessed this role after donor lymphocyte infusions (DLIs) by quantifying Treg in DLI products, using the CD25, Foxp3 but also the recently identified CD127 Treg markers. Compared with others, patients in durable complete remission of their malignancy after DLI had received a lower number of FoxP3CD25, FoxP3CD127, or CD4CD127 Treg cells (P=0.04). The CD4CD127 Treg content of DLI remained significantly correlated with the hematologic response in multivariate analysis (P=0.05). Treg may thus inhibit graft-versus-tumor effect after DLI, a setting where the antitumoral effect observed is only driven by T-cell-mediated cytotoxicity, independently of any other associated treatment. In comparison with the intracytoplasmic Foxp3 marker, the membranous CD4CD127 phenotype of Treg could be particularly relevant to manipulate this cell-population, to increase the antitumoral response in strategies of allogeneic or autologous immunotherapy.
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Haniffa M, Ginhoux F, Wang XN, Bigley V, Abel M, Dimmick I, Bullock S, Grisotto M, Booth T, Taub P, Hilkens C, Merad M, Collin M. Differential rates of replacement of human dermal dendritic cells and macrophages during hematopoietic stem cell transplantation. J Exp Med 2009; 206:371-85. [PMID: 19171766 PMCID: PMC2646566 DOI: 10.1084/jem.20081633] [Citation(s) in RCA: 198] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 12/18/2008] [Indexed: 12/12/2022] Open
Abstract
Animal models of hematopoietic stem cell transplantation have been used to analyze the turnover of bone marrow-derived cells and to demonstrate the critical role of recipient antigen-presenting cells (APC) in graft versus host disease (GVHD). In humans, the phenotype and lineage relationships of myeloid-derived tissue APC remain incompletely understood. It has also been proposed that the risk of acute GVHD, which extends over many months, is related to the protracted survival of certain recipient APC. Human dermis contains three principal subsets of CD45(+)HLA-DR(+) cells: CD1a(+)CD14(-) DC, CD1a(-)CD14(+) DC, and CD1a(-)CD14(+)FXIIIa(+) macrophages. In vitro, each subset has characteristic properties. After transplantation, both CD1a(+) and CD14(+) DC are rapidly depleted and replaced by donor cells, but recipient macrophages can be found in GVHD lesions and may persist for many months. Macrophages isolated from normal dermis secrete proinflammatory cytokines. Although they stimulate little proliferation of naive or memory CD4(+) T cells, macrophages induce cytokine expression in memory CD4(+) T cells and activation and proliferation of CD8(+) T cells. These observations suggest that dermal macrophages and DC are from distinct lineages and that persistent recipient macrophages, although unlikely to initiate alloreactivity, may contribute to GVHD by sustaining the responses of previously activated T cells.
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Affiliation(s)
- Muzlifah Haniffa
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, England, UK
| | - Florent Ginhoux
- Department of Gene and Cell Medicine, Mount Sinai School of Medicine, New York, NY 10029
| | - Xiao-Nong Wang
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, England, UK
| | - Venetia Bigley
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, England, UK
| | - Michal Abel
- Department of Gene and Cell Medicine, Mount Sinai School of Medicine, New York, NY 10029
| | - Ian Dimmick
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, England, UK
| | - Sarah Bullock
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, England, UK
| | - Marcos Grisotto
- Department of Gene and Cell Medicine, Mount Sinai School of Medicine, New York, NY 10029
| | - Trevor Booth
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, England, UK
| | - Peter Taub
- Department of Gene and Cell Medicine, Mount Sinai School of Medicine, New York, NY 10029
| | - Catharien Hilkens
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, England, UK
| | - Miriam Merad
- Department of Gene and Cell Medicine, Mount Sinai School of Medicine, New York, NY 10029
| | - Matthew Collin
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, England, UK
- Department of Gene and Cell Medicine, Mount Sinai School of Medicine, New York, NY 10029
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Frey NV, Porter DL. Graft-versus-host disease after donor leukocyte infusions: presentation and management. Best Pract Res Clin Haematol 2008; 21:205-22. [PMID: 18503987 DOI: 10.1016/j.beha.2008.02.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Donor leukocyte infusion (DLI) is used after both myeloablative and non-myeloablative stem-cell transplantation to treat and prevent relapse, to establish full donor chimerism, and to treat and prevent infections. The major treatment-related complication of DLI is graft-versus-host disease (GVHD). The presentation and treatment of GVHD after DLI is similar to its presentation and treatment after stem-cell transplantation, with some notable exceptions. While GVHD and graft-versus-tumor (GVT) effects are highly correlated after DLI, some patients experience remission without GVHD. Studies to define tumor-specific target antigens and GVT effector cells, as well as strategies of donor T-cell manipulation and optimization of DLI dose and schedule, may ultimately lead to the consistent ability to separate GVHD from GVT activity, improvement in the safety and specificity of DLI, and enhancement of the anti-tumor activity of donor T cells.
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Affiliation(s)
- Noelle V Frey
- Division of Hematology-Oncology and Abramson Cancer Center, University of Pennsylvania Medical Center, 16 Penn Tower, 3400 ISpruce St, Philadelphia PA 19106, USA
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Donor lymphocyte infusions: the long and winding road: how should it be traveled? Bone Marrow Transplant 2008; 42:569-79. [PMID: 18711351 DOI: 10.1038/bmt.2008.259] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Donor lymphocyte infusions (DLI) often are used after allo-SCT to augment the graft-versus-tumor effect. Timing of infusion varies according to indication, for example to treat tumor recurrence, as a planned strategy to prevent disease relapse in the setting of T-cell-depleted grafts or non-myeloablative conditioning regimens, or as a method to convert mixed to full donor chimerism. The optimal strategy of timing, use of cytotoxic conditioning, cell dose and cell product composition, and so on, for DLI administration remains unclear. Despite varied techniques, DLI may lead to 3-year disease-free survivals (DFS) in excess of 60% for all CML patients and approach 90% in patients with only molecular or cytogenetic relapse. Other hematologic malignancies appear much less responsive, as less than 50% of patients respond and provide, at best, 3-year DFS rates of 20-50%. Multiple myeloma patients have overall response rates of 40-45% after DLI, suggesting benefit in relapsed disease, but limited experiences for diseases such as Hodgkin's lymphoma, myelodysplasia and ALL preclude recommendations for use of DLI at this time. Regardless of the indication, treatment-related mortality after DLI is 5-20% and more than one-third of patients will develop acute and/or chronic GVHD after DLI. The risks of these complications appear related, in part, to donor source, cell dose and therapy prior to DLI. Although there are no definitive answers, the information gleaned from published literature suggests that DLI should be administered early after relapse or as a prophylactic strategy in patients receiving T-cell-depleted grafts, and patients with bulky or aggressive disease may benefit from disease reduction prior to DLI.
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Reply to ‘Splenectomy status of the patient may have impact on response to donor lymphocyte infusions’ by Duygu Uckan-Çetinkaya et al. Leukemia 2007. [DOI: 10.1038/sj.leu.2404804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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