Clinical Evidence of a Graft-versus-lymphoma Effect Against Relapsed Diffuse Large B-cell Lymphoma After Allogeneic Hematopoietic Stem-cell Transplantation

Overview

Journal Ann Oncol

Publisher Elsevier

Specialty Oncology

Date 2008 Aug 8

PMID 18684698

Citations 32

Authors

M R Bishop

R M Dean

S M Steinberg

J Odom

S Z Pavletic

C Chow

S Pittaluga

C Sportes

N M Hardy

J Gea-Banacloche

A Kolstad

R E Gress

D H Fowler

Affiliations

Soon will be listed here.

Abstract

Background: A graft-versus-lymphoma effect against diffuse large B-cell lymphoma (DLBCL) is inferred by sustained relapse-free survival after allogeneic stem-cell transplantation; however, there are limited data on a direct graft-versus-lymphoma effect against DLBCL following immunotherapeutic intervention by either withdrawal of immunosuppression or donor lymphocyte infusion (DLI).

Materials And Methods: An analysis was carried out to determine whether a direct graft-versus-lymphoma effect exists against DLBCL. The analysis was restricted to patients with DLBCL, who were either not in complete remission at day +100 after allogeneic stem-cell transplantation or subsequently relapsed beyond this time point.

Results: Fifteen patients were identified as either not in complete remission (n = 13) at their day +100 evaluation or subsequently relapsed (n = 2) and were assessed for subsequent responses after withdrawal of immunosuppression or DLI. Eleven patients were treated with either withdrawal of immunosuppression (n = 10) or a DLI (n = 1) alone; four patients received chemotherapy with DLI to reduce tumor bulk. Nine (60%) patients subsequently responded (complete = 8, partial = 1). Six responses occurred after withdrawal of immunosuppression alone. Six patients are alive (range 42-83+ months) in complete remission without further treatment.

Conclusion: The demonstration of sustained complete remission following immunotherapeutic intervention provides direct evidence of a graft-versus-lymphoma effect against DLBCL.

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