Low-dose total body irradiation followed by allogeneic lymphocyte infusion may induce remission in patients with refractory hematologic malignancy

被引:43
作者
Ballen, KK
Becker, PS
Emmons, RVB
Fitzgerald, TJ
Hsieh, CC
Liu, Q
Heyes, C
Clark, Y
Levy, W
Lambert, JF
Chiafari, F
Szymanski, I
Rososhansky, S
Popovsky, MA
Stewart, FM
Quesenberry, PJ
机构
[1] Univ Massachusetts Mem Hlth Care, Ctr Canc, Worcester, MA USA
[2] Univ Massachusetts Mem Hlth Care, Dept Med, Worcester, MA USA
[3] Univ Massachusetts Mem Hlth Care, Dept Radiat Oncol, Worcester, MA USA
[4] Univ Massachusetts Mem Hlth Care, Dept Pathol, Worcester, MA USA
[5] Baltimore Rh Typing Lab, Baltimore, MD USA
[6] American Red Cross, Cord Blood Program, Dedham, MA USA
关键词
D O I
10.1182/blood.V100.2.442
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Allogeneic stem cell transplantation is curative for certain cancers, but the high doses of chemotherapy/radiotherapy lead to toxicity. Here, we treat patients with refractory cancer with 100 cGy total body irradiation (TBI) followed by infusion of nonmobilized pheresed allogeneic peripheral blood cells. Twenty-five patients, with a median age of 47 years, with refractory cancers were enrolled. Eighteen patients received sibling and 7 received unrelated cord blood cells. Donor chimerism was assessed at weeks 1, 2, 3, 4, and 8 after transplantation. Seven patients with solid tumors received a sibling transplant and 6 received a cord blood transplant; none achieved donor chimerism, but 1 treated at the higher dose level of 1 x 108 CD3(+) cells/kg had a transient nodal response. Twelve patients with hematologic malignancies were treated; 1 received a cord blood transplant and 11 received sibling donor cells. Nine of these 11 patients achieved donor chimerism, ranging from 5% to 100%. Four patients had sustained complete remission of their cancers, including one patient with transient 5% donor chimerism. The development of chimerism correlated with hematologic malignancy (P <.001), total previous myelotoxic chemotherapy (P <.001), T-cell dose (P=.03), and graft-versus-host disease (P=.01). Tumor response correlated with donor chimerism (P=.01). Engraftment was achieved In patients with hematologic malignancies who had been heavily pretreated, suggesting the degree of immunosuppression may be a determinant of engraftment. Low-dose TBI and allogeneic lymphocyte Infusion may Induce remission In patients with refractory hematologic malignancy. (Blood. 2002; 100:442-450). (C) 2002 by The American Society of Hematology.
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页码:442 / 450
页数:9
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