Addition of a low fixed number of CD3+ cells to @entity2280 -enriched allografts: effects on engraftment, XXXX , and survival after related and unrelated peripheral stem cell transplantation.

@entity1 @entity1071 @entity5 @entity2800 @entity3052 @entity2132 @entity2280
Despite prophylaxis with immunosuppressive drugs, severe @entity2132 ( @entity2132 ) remains a major cause of morbidity and mortality following allogeneic stem cell transplantation. T cell depletion of the graft has decreased incidence and severity of @entity2132 but has resulted in a higher incidence of graft failure and relapse. To reduce the risk of severe @entity2132 , but at the same time to maintain the graft-versus- @entity5 effect, we administered a fixed low number of 1 x 10(5) donor T cells per kilogram of body weight to recipients of @entity2280 (+) cell-enriched allogeneic peripheral blood stem cells (PBSCs). Donor lymphocyte infusions (DLI) were then given in incremental doses when mixed chimerism persisted or signs of relapse occurred. A total of 23 @entity1 receiving allografts from related and unrelated donors were treated according to this protocol after myeloablative or reduced intensity conditioning. One @entity1 did not engraft and 3/20 evaluable @entity1 developed acute (a) @entity2132 > or = grade II, with a corresponding estimated cumulative incidence of 15.6% (95% CI 0-30.5%). DLI (n = 13) induced aGVHD > or = II in 6 @entity1 , but the severity of the syndrome was reduced. Overall @entity2132 -related mortality was low (13%). The probability of disease-free survival and overall survival at 2 years was 0.40 (95% CI 0.21-0.75) and 0.36 (95% CI 0.21-0.63). Progression-free survival and overall survival was significantly better in @entity1 with @entity3052 compared to @entity1 with @entity1071 (p = 0.002; p = 0.02). We conclude that the combination of allografts with a T cell content of about 1 x 10(5)/kg and escalating doses of DLI is a viable transplant strategy in @entity1 with @entity2800 , which results in stable engraftment and a reduction of mortality from aGVHD.
