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- Publisher Website: 10.1002/ajh.24949
- Scopus: eid_2-s2.0-85034227038
- PMID: 29047161
- WOS: WOS:000419455900012
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Article: Donor lymphocyte infusion and methotrexate for immune recovery after T-cell depleted haploidentical transplantation
Title | Donor lymphocyte infusion and methotrexate for immune recovery after T-cell depleted haploidentical transplantation |
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Authors | |
Issue Date | 2018 |
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 Identifier | http://hdl.handle.net/10722/294520 |
ISSN | 2023 Impact Factor: 10.1 2023 SCImago Journal Rankings: 2.607 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Gilman, Andrew L. | - |
dc.contributor.author | Leung, Wing | - |
dc.contributor.author | Cowan, Morton J. | - |
dc.contributor.author | Cannon, Mark | - |
dc.contributor.author | Epstein, Stacy | - |
dc.contributor.author | Barnhart, Carrie | - |
dc.contributor.author | Shah, Krishna | - |
dc.contributor.author | Hyland, Michelle | - |
dc.contributor.author | Fukes, Tracy | - |
dc.contributor.author | Ivanova, Anastasia | - |
dc.date.accessioned | 2020-12-03T08:22:55Z | - |
dc.date.available | 2020-12-03T08:22:55Z | - |
dc.date.issued | 2018 | - |
dc.identifier.citation | American Journal of Hematology, 2018, v. 93, n. 2, p. 169-178 | - |
dc.identifier.issn | 0361-8609 | - |
dc.identifier.uri | http://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.language | eng | - |
dc.relation.ispartof | American Journal of Hematology | - |
dc.title | Donor lymphocyte infusion and methotrexate for immune recovery after T-cell depleted haploidentical transplantation | - |
dc.type | Article | - |
dc.description.nature | link_to_OA_fulltext | - |
dc.identifier.doi | 10.1002/ajh.24949 | - |
dc.identifier.pmid | 29047161 | - |
dc.identifier.scopus | eid_2-s2.0-85034227038 | - |
dc.identifier.volume | 93 | - |
dc.identifier.issue | 2 | - |
dc.identifier.spage | 169 | - |
dc.identifier.epage | 178 | - |
dc.identifier.eissn | 1096-8652 | - |
dc.identifier.isi | WOS:000419455900012 | - |
dc.identifier.issnl | 0361-8609 | - |