文章：

基于嵌合和供体来源的风险适应供体淋巴细胞输注治疗儿童白血病

Risk-adapted donor lymphocyte infusion based on chimerism and donor source in pediatric leukemia

原文发布日期：2013-08-30

DOI: 10.1038/bcj.2013.39

类型: Original Article

开放获取: 是

英文摘要：

Donor lymphocyte infusion (DLI) is commonly used to treat leukemia relapse following stem cell transplantation. In florid relapse, however, the efficacy of DLI is limited with substantial risk of severe graft-versus-host disease (GvHD). Here, we develop a novel risk-adapted strategy characterized by pre-emptive DLI initiated at the time of mixed chimerism, a small starting dose based on donor source, dose-escalation guided by real-time chimerism monitoring and withholding of DLI immediately in patients achieving full donor chimerism. A total of 178 DLIs were given to 38 patients with mixed chimerism; thereafter, 33 patients (86.8%) had donor chimerism successfully increased, including 30 (78.9%) who had chimerism fully converted back to 100% donor. Cumulative incidence of relapse was significantly lower (P=0.00004) and overall survival higher (P=0.0003) in patients with chimerism fully corrected as compared with those of patients whose chimerism remained mixed. Only 13.2% of the patients developed acute grade III-IV GvHD with no associated mortality. In conclusion, the risk-adapted DLI strategy is useful in minimizing the risk of childhood leukemia relapse, GvHD and death.

摘要翻译： 

供者淋巴细胞输注（DLI）常用于治疗干细胞移植后白血病复发。但在疾病全面复发期，DLI的疗效有限且伴有严重的移植物抗宿主病（GvHD）风险。本研究开发了一种新型风险适应策略，其特点包括：在混合嵌合状态时启动抢先式DLI、根据供体来源设定小剂量起始方案、通过实时嵌合监测指导剂量递增、以及在实现完全供体嵌合时立即停止DLI。对38例混合嵌合患者共进行178次DLI治疗后，33例（86.8%）患者供体嵌合率成功提升，其中30例（78.9%）完全恢复为100%供体嵌合。与持续混合嵌合患者相比，嵌合状态完全校正者的累计复发率显著降低（P=0.00004），总生存率明显提高（P=0.0003）。仅13.2%患者发生急性III-IV级GvHD且无相关死亡病例。结论：风险适应性DLI策略可有效降低儿童白血病复发风险、GvHD发生率和死亡率。

原文链接：

Risk-adapted donor lymphocyte infusion based on chimerism and donor source in pediatric leukemia