Treatment of relapsed leukemia after unrelated donor marrow transplantation with unrelated donor leukocyte infusions

David L. Porter, Robert H. Collins, 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, Joseph H. Antin

Research output: Contribution to journalArticlepeer-review

155 Scopus citations

Abstract

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 [Cl], 28%-56%) achieved CR, including 11 of 24 (46%; 95% Cl, 26%-66%) with CML, 8 of 19 (42%; 95% Cl, 20%-64%) with AML, and 2 of 4 (50%; 95% Cl, 1%-99%) with ALL. The estimated probability of disease-free survival (DFS) at 1 year after CR was 65% (95% Cl, 50%-79%) for CML, 23% (95% Cl, 9%-38%) for AML, and 30% (95% Cl, 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. (C) 2000 by The American Society of Hematology.

Original languageEnglish (US)
Pages (from-to)1214-1221
Number of pages8
JournalBlood
Volume95
Issue number4
StatePublished - Feb 15 2000

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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