Katsutsugu Umeda1, Souichi Adachi2, Shiro Tanaka3, Mizuka Miki4, Keiko Okada5, Yoshiko Hashii6, Masami Inoue7, Yuko Cho8, Katsuyoshi Koh9, Hiroaki Goto10, Ryosuke Kajiwara11, Nobuyuki Hyakuna12, Koji Kato13, Tomohiro Morio14, Hiromasa Yabe15. 1. Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan. umeume@kuhp.kyoto-u.ac.jp. 2. Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 3. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan. 4. Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan. 5. Department of Pediatric Hematology/Oncology, Osaka City General Hospital, Osaka, Japan. 6. Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan. 7. Department of Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan. 8. Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan. 9. Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan. 10. Division of Hemato-oncology/Regenerative Medicine, Kanagawa Children's Medical Center, Kanagawa, Japan. 11. Department of Pediatrics, Yokohama City University School of Medicine, Yokohama, Japan. 12. Center of Bone Marrow Transplantation, Ryukyu University Hospital, Okinawa, Japan. 13. Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan. 14. Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan. 15. Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, Isehara, Japan.
Abstract
BACKGROUND: Donor mixed chimerism (MC) is an increasing problem after hematopoietic stem cell transplantation (HSCT) for nonmalignant diseases. PROCEDURE: In this study, a self-administered questionnaire was used to retrospectively compare efficacy and safety in 49 patients undergoing second HSCT (n = 13) or donor lymphocyte infusion (DLI; n = 36) as treatment for MC. RESULTS: The response rate to DLI of patients with secondary graft failure (GF) (25.0%) was significantly lower than that of patients without secondary GF (81.3%; P = 0.041). Among patients undergoing DLI, the rates of successful response were significantly higher in patients having at least 30% donor chimerism (94.1%) than in patients having less than 30% donor chimerism (61.1%; P = 0.041). Furthermore, the rates of successful response were significantly higher in patients receiving larger first or maximum doses of DLI. Sixteen (50.0%) of 32 patients without secondary GF attained complete chimerism after DLI. The cumulative incidence of grade II-IV acute graft-versus-host disease and cytopenia was 37.6 and 26.1%, respectively. CONCLUSIONS: DLI yields promising response rates in most patients with higher donor chimerism levels, whereas second HSCT is more likely to benefit patients with lower donor chimerism levels.
BACKGROUND:Donor mixed chimerism (MC) is an increasing problem after hematopoietic stem cell transplantation (HSCT) for nonmalignant diseases. PROCEDURE: In this study, a self-administered questionnaire was used to retrospectively compare efficacy and safety in 49 patients undergoing second HSCT (n = 13) or donor lymphocyte infusion (DLI; n = 36) as treatment for MC. RESULTS: The response rate to DLI of patients with secondary graft failure (GF) (25.0%) was significantly lower than that of patients without secondary GF (81.3%; P = 0.041). Among patients undergoing DLI, the rates of successful response were significantly higher in patients having at least 30% donor chimerism (94.1%) than in patients having less than 30% donor chimerism (61.1%; P = 0.041). Furthermore, the rates of successful response were significantly higher in patients receiving larger first or maximum doses of DLI. Sixteen (50.0%) of 32 patients without secondary GF attained complete chimerism after DLI. The cumulative incidence of grade II-IV acute graft-versus-host disease and cytopenia was 37.6 and 26.1%, respectively. CONCLUSIONS: DLI yields promising response rates in most patients with higher donor chimerism levels, whereas second HSCT is more likely to benefit patients with lower donor chimerism levels.