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Article: Donor lymphocyte infusion and methotrexate for immune recovery after T-cell depleted haploidentical transplantation

TitleDonor lymphocyte infusion and methotrexate for immune recovery after T-cell depleted haploidentical transplantation
Authors
Issue Date2018
Citation
American Journal of Hematology, 2018, v. 93, n. 2, p. 169-178 How to Cite?
Abstract© 2017 Wiley Periodicals, Inc. CD34+ cell selection minimizes graft-versus-host disease (GVHD) after haploidentical donor stem cell transplant but is associated with slow immune recovery and infections. We report a Phase I/II study of prophylactic donor lymphocyte infusion (DLI) followed by methotrexate (MTX) GVHD prophylaxis after CD34-selected haploidentical donor transplant. A prophylactic DLI was given between day +30 and +42. Rituximab was given with DLI for the last 10 patients. The goal of the study was to determine a DLI dose that would result in a CD4+ cell count > 100/µL at Day +120 in ≥ 66% of patients with ≤ 33% grade II-III, ≤ 17% grade III, and no grade IV acute GVHD by Day +180. Thirty-five patients with malignant (n = 25) or nonmalignant disease (n = 10) were treated after CD34-selected haploidentical donor peripheral blood stem cell transplant. The DLI dose of 5 × 104/kg met the CD4/GVHD goal with 67% of patients having CD4+ cells > 100/µL and 11% grade II-IV acute GVHD. The cumulative incidence of chronic GVHD was 16%. Fatal viral and fungal infections occurred in 11%. The 2 year estimated overall survival was 69% and the relapse rate was 14% for patients in remission at transplant. There was no effect of NK alloreactivity on relapse. Nine of ten patients at the target DLI dose cohort of 5 × 104/kg are alive with median follow-up of 18 mos (range 6-29). Delayed prophylactic DLI and MTX was associated with promising outcomes at the target DLI dose. This trial was registered at clinicaltrials.gov, # NCT01027702.
Persistent Identifierhttp://hdl.handle.net/10722/294520
ISSN
2023 Impact Factor: 10.1
2023 SCImago Journal Rankings: 2.607
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorGilman, Andrew L.-
dc.contributor.authorLeung, Wing-
dc.contributor.authorCowan, Morton J.-
dc.contributor.authorCannon, Mark-
dc.contributor.authorEpstein, Stacy-
dc.contributor.authorBarnhart, Carrie-
dc.contributor.authorShah, Krishna-
dc.contributor.authorHyland, Michelle-
dc.contributor.authorFukes, Tracy-
dc.contributor.authorIvanova, Anastasia-
dc.date.accessioned2020-12-03T08:22:55Z-
dc.date.available2020-12-03T08:22:55Z-
dc.date.issued2018-
dc.identifier.citationAmerican Journal of Hematology, 2018, v. 93, n. 2, p. 169-178-
dc.identifier.issn0361-8609-
dc.identifier.urihttp://hdl.handle.net/10722/294520-
dc.description.abstract© 2017 Wiley Periodicals, Inc. CD34+ cell selection minimizes graft-versus-host disease (GVHD) after haploidentical donor stem cell transplant but is associated with slow immune recovery and infections. We report a Phase I/II study of prophylactic donor lymphocyte infusion (DLI) followed by methotrexate (MTX) GVHD prophylaxis after CD34-selected haploidentical donor transplant. A prophylactic DLI was given between day +30 and +42. Rituximab was given with DLI for the last 10 patients. The goal of the study was to determine a DLI dose that would result in a CD4+ cell count > 100/µL at Day +120 in ≥ 66% of patients with ≤ 33% grade II-III, ≤ 17% grade III, and no grade IV acute GVHD by Day +180. Thirty-five patients with malignant (n = 25) or nonmalignant disease (n = 10) were treated after CD34-selected haploidentical donor peripheral blood stem cell transplant. The DLI dose of 5 × 104/kg met the CD4/GVHD goal with 67% of patients having CD4+ cells > 100/µL and 11% grade II-IV acute GVHD. The cumulative incidence of chronic GVHD was 16%. Fatal viral and fungal infections occurred in 11%. The 2 year estimated overall survival was 69% and the relapse rate was 14% for patients in remission at transplant. There was no effect of NK alloreactivity on relapse. Nine of ten patients at the target DLI dose cohort of 5 × 104/kg are alive with median follow-up of 18 mos (range 6-29). Delayed prophylactic DLI and MTX was associated with promising outcomes at the target DLI dose. This trial was registered at clinicaltrials.gov, # NCT01027702.-
dc.languageeng-
dc.relation.ispartofAmerican Journal of Hematology-
dc.titleDonor lymphocyte infusion and methotrexate for immune recovery after T-cell depleted haploidentical transplantation-
dc.typeArticle-
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1002/ajh.24949-
dc.identifier.pmid29047161-
dc.identifier.scopuseid_2-s2.0-85034227038-
dc.identifier.volume93-
dc.identifier.issue2-
dc.identifier.spage169-
dc.identifier.epage178-
dc.identifier.eissn1096-8652-
dc.identifier.isiWOS:000419455900012-
dc.identifier.issnl0361-8609-

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