Donor leukocyte infusions in 140 patients with relapsed malignancy after allogeneic bone marrow transplantation

R. H. Collins, O. Shpilberg, W. R. Drobyski, D. L. Porter, S. Giralt, R. Champlin, S. A. Goodman, S. N. Wolff, W. Hu, C. Verfaillie, A. List, W. Dalton, N. Ognoskie, A. Chetrit, J. H. Antin, J. Nemunaitis

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Abstract

Purpose: Recipients of allogeneic bone marrow transplants (BMTs) who have relapsed may attain complete remissions when treated with transfusions of leukocytes obtained from the original bone marrow donor. We performed a retrospective study to characterize better this new treatment modality. Patients and Methods: We surveyed 25 North American BMT programs regarding their use of donor leukocyte infusions (DLI). Detailed forms were used to gather data regarding the original BMT, relapse, DLI, response to DLI, complications of DLI, and long-term follow-up evaluation. Reports of 140 patients were thus available for analysis. Results: Complete responses were observed in 60% (95% confidence interval [CI], 51.9% to 68.1%) of chronic myelogenous leukemia (CML) patients who received DLI and did not receive pre- DLI chemotherapy; response rates were higher in patients with cytogenetic and chronic-phase relapse (75.7%; 95% CI, 68.2% to 83.2%) than in patients with accelerated-phase (33.3%; 95% CI, 19.7% to 46.9%) or blastic-phase (16.7%; 95% CI, 1.9% to 31.9%) relapse. The actuarial probability of remaining in complete remission at 2 years was 89.6%. Complete remission rates in acute myelogenous leukemia (AML) (n= 39) and acute lymphocytic leukemia (ALL) (n = 11) patients who had not received pre-DLI chemotherapy were 15.4% (95% CI, 9.6% to 21.2%) and 18.2% (95% CI, 6.6% to 29.8%), respectively. Complete remissions were also observed in two of four assessable myeloma patients and two of five assessable myelodysplasia patients. Complications of DLI included acute graft-versus-host disease (GVHD) (60%; 95% CI, 51.4% to 68.6%), chronic GVHD (60.7%; 95% CI, 50.3% to 71.1%), and pancytopenia (18.6%; 95% CI, 12.2% to 25.0%). Pre-DLI characteristics predictive of complete response in CML patients were post-BMT chronic GVHD, pre-DLI disease status of chronic phase, and time interval between BMT to DLI less than 2 years. Acute and chronic GVHD post-DLI were highly correlated with disease response (P < .00001). Conclusion: DLI results in complete remissions in a high percentage of patients with relapsed chronic-phase CML. Complete remissions are observed less frequently in patients with advanced CML and acute leukemia. GVHD and pancytopenia occur commonly; GVHD is highly correlated with response.

Original languageEnglish (US)
Pages (from-to)433-444
Number of pages12
JournalJournal of Clinical Oncology
Volume15
Issue number2
StatePublished - Feb 1997

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Homologous Transplantation
Bone Marrow Transplantation
Leukocytes
Tissue Donors
Graft vs Host Disease
Confidence Intervals
Neoplasms
Bone Marrow
Transplants
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Pancytopenia
Recurrence
Leukocyte Transfusion
Leukemia, Myeloid, Chronic Phase
Drug Therapy
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Acute Myeloid Leukemia
Cytogenetics
Leukemia
Chronic Disease

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Collins, R. H., Shpilberg, O., Drobyski, W. R., Porter, D. L., Giralt, S., Champlin, R., ... Nemunaitis, J. (1997). Donor leukocyte infusions in 140 patients with relapsed malignancy after allogeneic bone marrow transplantation. Journal of Clinical Oncology, 15(2), 433-444.

Donor leukocyte infusions in 140 patients with relapsed malignancy after allogeneic bone marrow transplantation. / Collins, R. H.; Shpilberg, O.; Drobyski, W. R.; Porter, D. L.; Giralt, S.; Champlin, R.; Goodman, S. A.; Wolff, S. N.; Hu, W.; Verfaillie, C.; List, A.; Dalton, W.; Ognoskie, N.; Chetrit, A.; Antin, J. H.; Nemunaitis, J.

In: Journal of Clinical Oncology, Vol. 15, No. 2, 02.1997, p. 433-444.

Research output: Contribution to journalArticle

Collins, RH, Shpilberg, O, Drobyski, WR, Porter, DL, Giralt, S, Champlin, R, Goodman, SA, Wolff, SN, Hu, W, Verfaillie, C, List, A, Dalton, W, Ognoskie, N, Chetrit, A, Antin, JH & Nemunaitis, J 1997, 'Donor leukocyte infusions in 140 patients with relapsed malignancy after allogeneic bone marrow transplantation', Journal of Clinical Oncology, vol. 15, no. 2, pp. 433-444.
Collins, R. H. ; Shpilberg, O. ; Drobyski, W. R. ; Porter, D. L. ; Giralt, S. ; Champlin, R. ; Goodman, S. A. ; Wolff, S. N. ; Hu, W. ; Verfaillie, C. ; List, A. ; Dalton, W. ; Ognoskie, N. ; Chetrit, A. ; Antin, J. H. ; Nemunaitis, J. / Donor leukocyte infusions in 140 patients with relapsed malignancy after allogeneic bone marrow transplantation. In: Journal of Clinical Oncology. 1997 ; Vol. 15, No. 2. pp. 433-444.
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abstract = "Purpose: Recipients of allogeneic bone marrow transplants (BMTs) who have relapsed may attain complete remissions when treated with transfusions of leukocytes obtained from the original bone marrow donor. We performed a retrospective study to characterize better this new treatment modality. Patients and Methods: We surveyed 25 North American BMT programs regarding their use of donor leukocyte infusions (DLI). Detailed forms were used to gather data regarding the original BMT, relapse, DLI, response to DLI, complications of DLI, and long-term follow-up evaluation. Reports of 140 patients were thus available for analysis. Results: Complete responses were observed in 60{\%} (95{\%} confidence interval [CI], 51.9{\%} to 68.1{\%}) of chronic myelogenous leukemia (CML) patients who received DLI and did not receive pre- DLI chemotherapy; response rates were higher in patients with cytogenetic and chronic-phase relapse (75.7{\%}; 95{\%} CI, 68.2{\%} to 83.2{\%}) than in patients with accelerated-phase (33.3{\%}; 95{\%} CI, 19.7{\%} to 46.9{\%}) or blastic-phase (16.7{\%}; 95{\%} CI, 1.9{\%} to 31.9{\%}) relapse. The actuarial probability of remaining in complete remission at 2 years was 89.6{\%}. Complete remission rates in acute myelogenous leukemia (AML) (n= 39) and acute lymphocytic leukemia (ALL) (n = 11) patients who had not received pre-DLI chemotherapy were 15.4{\%} (95{\%} CI, 9.6{\%} to 21.2{\%}) and 18.2{\%} (95{\%} CI, 6.6{\%} to 29.8{\%}), respectively. Complete remissions were also observed in two of four assessable myeloma patients and two of five assessable myelodysplasia patients. Complications of DLI included acute graft-versus-host disease (GVHD) (60{\%}; 95{\%} CI, 51.4{\%} to 68.6{\%}), chronic GVHD (60.7{\%}; 95{\%} CI, 50.3{\%} to 71.1{\%}), and pancytopenia (18.6{\%}; 95{\%} CI, 12.2{\%} to 25.0{\%}). Pre-DLI characteristics predictive of complete response in CML patients were post-BMT chronic GVHD, pre-DLI disease status of chronic phase, and time interval between BMT to DLI less than 2 years. Acute and chronic GVHD post-DLI were highly correlated with disease response (P < .00001). Conclusion: DLI results in complete remissions in a high percentage of patients with relapsed chronic-phase CML. Complete remissions are observed less frequently in patients with advanced CML and acute leukemia. GVHD and pancytopenia occur commonly; GVHD is highly correlated with response.",
author = "Collins, {R. H.} and O. Shpilberg and Drobyski, {W. R.} and Porter, {D. L.} and S. Giralt and R. Champlin and Goodman, {S. A.} and Wolff, {S. N.} and W. Hu and C. Verfaillie and A. List and W. Dalton and N. Ognoskie and A. Chetrit and Antin, {J. H.} and J. Nemunaitis",
year = "1997",
month = "2",
language = "English (US)",
volume = "15",
pages = "433--444",
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TY - JOUR

T1 - Donor leukocyte infusions in 140 patients with relapsed malignancy after allogeneic bone marrow transplantation

AU - Collins, R. H.

AU - Shpilberg, O.

AU - Drobyski, W. R.

AU - Porter, D. L.

AU - Giralt, S.

AU - Champlin, R.

AU - Goodman, S. A.

AU - Wolff, S. N.

AU - Hu, W.

AU - Verfaillie, C.

AU - List, A.

AU - Dalton, W.

AU - Ognoskie, N.

AU - Chetrit, A.

AU - Antin, J. H.

AU - Nemunaitis, J.

PY - 1997/2

Y1 - 1997/2

N2 - Purpose: Recipients of allogeneic bone marrow transplants (BMTs) who have relapsed may attain complete remissions when treated with transfusions of leukocytes obtained from the original bone marrow donor. We performed a retrospective study to characterize better this new treatment modality. Patients and Methods: We surveyed 25 North American BMT programs regarding their use of donor leukocyte infusions (DLI). Detailed forms were used to gather data regarding the original BMT, relapse, DLI, response to DLI, complications of DLI, and long-term follow-up evaluation. Reports of 140 patients were thus available for analysis. Results: Complete responses were observed in 60% (95% confidence interval [CI], 51.9% to 68.1%) of chronic myelogenous leukemia (CML) patients who received DLI and did not receive pre- DLI chemotherapy; response rates were higher in patients with cytogenetic and chronic-phase relapse (75.7%; 95% CI, 68.2% to 83.2%) than in patients with accelerated-phase (33.3%; 95% CI, 19.7% to 46.9%) or blastic-phase (16.7%; 95% CI, 1.9% to 31.9%) relapse. The actuarial probability of remaining in complete remission at 2 years was 89.6%. Complete remission rates in acute myelogenous leukemia (AML) (n= 39) and acute lymphocytic leukemia (ALL) (n = 11) patients who had not received pre-DLI chemotherapy were 15.4% (95% CI, 9.6% to 21.2%) and 18.2% (95% CI, 6.6% to 29.8%), respectively. Complete remissions were also observed in two of four assessable myeloma patients and two of five assessable myelodysplasia patients. Complications of DLI included acute graft-versus-host disease (GVHD) (60%; 95% CI, 51.4% to 68.6%), chronic GVHD (60.7%; 95% CI, 50.3% to 71.1%), and pancytopenia (18.6%; 95% CI, 12.2% to 25.0%). Pre-DLI characteristics predictive of complete response in CML patients were post-BMT chronic GVHD, pre-DLI disease status of chronic phase, and time interval between BMT to DLI less than 2 years. Acute and chronic GVHD post-DLI were highly correlated with disease response (P < .00001). Conclusion: DLI results in complete remissions in a high percentage of patients with relapsed chronic-phase CML. Complete remissions are observed less frequently in patients with advanced CML and acute leukemia. GVHD and pancytopenia occur commonly; GVHD is highly correlated with response.

AB - Purpose: Recipients of allogeneic bone marrow transplants (BMTs) who have relapsed may attain complete remissions when treated with transfusions of leukocytes obtained from the original bone marrow donor. We performed a retrospective study to characterize better this new treatment modality. Patients and Methods: We surveyed 25 North American BMT programs regarding their use of donor leukocyte infusions (DLI). Detailed forms were used to gather data regarding the original BMT, relapse, DLI, response to DLI, complications of DLI, and long-term follow-up evaluation. Reports of 140 patients were thus available for analysis. Results: Complete responses were observed in 60% (95% confidence interval [CI], 51.9% to 68.1%) of chronic myelogenous leukemia (CML) patients who received DLI and did not receive pre- DLI chemotherapy; response rates were higher in patients with cytogenetic and chronic-phase relapse (75.7%; 95% CI, 68.2% to 83.2%) than in patients with accelerated-phase (33.3%; 95% CI, 19.7% to 46.9%) or blastic-phase (16.7%; 95% CI, 1.9% to 31.9%) relapse. The actuarial probability of remaining in complete remission at 2 years was 89.6%. Complete remission rates in acute myelogenous leukemia (AML) (n= 39) and acute lymphocytic leukemia (ALL) (n = 11) patients who had not received pre-DLI chemotherapy were 15.4% (95% CI, 9.6% to 21.2%) and 18.2% (95% CI, 6.6% to 29.8%), respectively. Complete remissions were also observed in two of four assessable myeloma patients and two of five assessable myelodysplasia patients. Complications of DLI included acute graft-versus-host disease (GVHD) (60%; 95% CI, 51.4% to 68.6%), chronic GVHD (60.7%; 95% CI, 50.3% to 71.1%), and pancytopenia (18.6%; 95% CI, 12.2% to 25.0%). Pre-DLI characteristics predictive of complete response in CML patients were post-BMT chronic GVHD, pre-DLI disease status of chronic phase, and time interval between BMT to DLI less than 2 years. Acute and chronic GVHD post-DLI were highly correlated with disease response (P < .00001). Conclusion: DLI results in complete remissions in a high percentage of patients with relapsed chronic-phase CML. Complete remissions are observed less frequently in patients with advanced CML and acute leukemia. GVHD and pancytopenia occur commonly; GVHD is highly correlated with response.

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