Adoptive Immunotherapy in the Treatment of Post-Transplant Relapse and Epstein-Barr Virus Lymphoproliferative Disorders

  • E. B. Papadopoulos
  • S. Mackinnon
  • J. W. Young
  • R. J. O’Reilly
Conference paper
Part of the Haematology and Blood Transfusion / Hämatologie und Bluttransfusion book series (HAEMATOLOGY, volume 39)

Abstract

Adoptive immunotherapy has recently been recognized as an effective treatment for both post-transplant relapse of chronic myelogenous leukemia (CML) and the treatment of post-transplant Epstein-Barr Virus lymphoproliferative disorders (EBV-LPD). Sixteen patients have received donor-derived leukocytes containing a dose of CD3+ cells ranging between 0.2–1.0 × 106 CD3+ cells/kg for treatment of EBV-LPD. Fifteen of the sixteen patients re-sponded with complete eradication of lym-phoma. Eight of thirteen evaluable patients developed either acute and/or chronic graft-vs.-host disease (GvHD). Of these eight, six exhibited mild GvHD and two pa-tients developed extensive chronic GvHD. Nine of the sixteen patients are alive and well approximately 6–50 months post-treat-ment. No patient has had recurrence of lymphoma.

Donor leukocyte infusions have also been effective in the treatment of post-transplant relapse of chronic myelogenous leukemia. We have utilized a dose escalation approach attempting to achieve a graft-vs.-leukemia effect without a graft-vs.-host re-action in patients with hematologic, cytogenetic, or molecular relapse of CML following T cell depleted transplants. Thirty-six patients have been treated with escalating doses of donor leukocytes ranging from 1 × 105−5 × 108 CD3+ cells/kg. Of these patients with hematologic (chronic phase or accelerated phase), cytogenetic, and/or molecular disease, thirty-two have responded. GvHD was seen in eleven of the responding pa-tients and none of the four nonresponders. Of the eleven patients developing GvHD, five developed limited chronic GvHD and six developed extensive GvHD. The dose of T cells required to achieve a response correlated with the status of disease at the time of the donor leukocyte infusion. In addition, the development of GvHD correlated with the cumulative dose of T cells administered. Dose escalations of donor derived lymphocytes result in durable remissions following post-transplant relapse of CML. Patients re-quiring a smaller dose of donor leukocytes to achieve remissions had a lower incidence of GvHD complicating this therapy.

Keywords

Toxicity Lymphoma Leukemia Pneumonia Penicillin 

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Copyright information

© Springer-Verlag Berlin Heidelberg 1998

Authors and Affiliations

  • E. B. Papadopoulos
    • 1
  • S. Mackinnon
    • 3
  • J. W. Young
    • 1
    • 2
  • R. J. O’Reilly
    • 1
  1. 1.Memorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.The Rockefeller UniversityNew YorkUSA
  3. 3.University College London HospitalLondonUK

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