Donor lymphocyte infusion after allogeneic stem cell transplantation in children

BACKGROUND: Donor lymphocyte infusion (DLI) is an important curative therapy for relapse or persistence of hematologic malignancy and bone marrow failure syndrome following allogeneic hematopoietic stem cell transplantation (allo HSCT). However, DLI is limited by the development of graft-versus-host disease (GVHD)and marrow aplasia, and the efficacy of DLIis not defined in children. So we evaluate DLI for last decade, and wantedtodescribeDLIoutcomesinasinglecenter. METHODS: We analyzed 8 patients who received a total of18 granulcyte colony stimulating factor (G-CSF) mobilized DLI at different intervals for treating leukemia relapse or persistence of severe a plastic anemia after allo HSCT in Ajou university hospital from 2001to2013. We evaluated childhood patients with Philadelphia gene positive acute lymphoblastic leukemia (ALL, n=3), Central nerve system involved ALL (n=1), Juvenile myelomonocytic leukemia (JMML,n=1), Acute myeloid leukemia(n=2), Severe aplastic anemia (SAA,n=1).Reasons for DLI were relapse in all leukemia and JMML 7patients and 1 SAA patient received DLI due to persistent bone marrow failure. RESULTS: Number of DLI was 1 in 3 patients and 2 more in 5 patients, median interval between transplantation and DLI was 7.2 (range,3.3-39.2 ) months and median number of initially infused CD3cells/Kg recipient body weight was1.04X 108 (range,0.5-6.75X 108).One patient developed severe acute gastrointestinal GVHD. After median follow up of 49months (2-120months),2 of7 leukemia patients who achieved complete remission (CR)and 1 SAA patient recovered donor’s full chimerism. But other leukemia patient did not achieve CR and 4 of5 expired due to disease progression. The patient with Philadelphia gene positive ALL survived by imatinib mesylate maintenance therapy although failure of DLI. Overall, 4 of 8patients were surviving and no patient died of GVHD and marrow aplasia. CONCLUSIONS: Our finding indicate that DLI after alloHSCT is well tolerated in sight of tolerable GVHD and low incidence of marrow aplasiain children, but other strategy will be needed to over come the leukemia relapse.

Author dc:creator

• 이, 성욱

Contributors dc:contributor

• 박, 준은
• 대학원 의학과
• 105211

• 공여자 림프구 주입술
• 동종조혈모세포이식술
• 재발
• Donorlymphocyte infusion (DLI)
• allogeneic hematopoietic stem celltransplantation(alloHSCT)
• Relapse

Language dc:language

ko

Identifier

http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000017601
000000017601

OAI identifier oai:identifier

oai:repository.ajou.ac.kr:201003/10929