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Escalating doses of donor lymphocytes for incipient graft rejection following SCT for thalassemia
Escalating doses of donor lymphocytes for incipient graft rejection following SCT for thalassemia BONE MARROW TRANSPLANTATION Frugnoli, I., Cappelli, B., Chiesa, R., Biral, E., Noe, A., Evangelio, C., Fossati, M., Napolitano, S., Ciceri, F., Roncarolo, M. G., Marktel, S. 2010; 45 (6): 1047-1051Abstract
Mixed chimerism (MC) and secondary graft failure are frequent events following SCT for thalassemia. There is limited information regarding the outcome of donor lymphocyte infusion (DLI) to prevent rejection, mainly from case reports describing only successful cases. We describe a series of seven children affected by beta-thalassemia treated with escalating doses of DLI for level 2-3 MC (donor<90%) following myeloablative SCT from a matched family donor. The infusions were safe and no acute or chronic GVHD were documented; five patients experienced neutropenia and thrombocytopenia resolving spontaneously. DLI was successful in converting to full donor chimerism two patients stratified in the low-risk class (Pesaro class II). Conversely, for five high-risk patients, DLI was not effective in preventing secondary graft failure. This limited series suggests that escalating doses of DLI are safe in thalassemia patients post myeloablative therapy but efficacy may be jeopardized by rapidly growing anti-donor alloimmunity in high-risk patients. We suggest giving escalating doses of donor T cells to attempt a graft-versus-thalassemia as soon as level 2-3 MC is detected.
View details for DOI 10.1038/bmt.2009.298
View details for Web of Science ID 000278573600013
View details for PubMedID 19881553