Table 1. Patient Characteristics.
Six patients developed viral infections concurrent with or immediately preceding LLME DLI. All had resolution or partial resolution of the viral disease. Four of six developed rapid recovery of CD3+/CD4+ cells. Two patients, who expired at days 35 and 46 s/p LLME DLI of other causes did not.
| Age/Gender | Disease | Graft Type | LLME DLI | Infection | Time to CD4>100 (days) | GVHD | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| CD3+ T Cell Dose/Kg | Days s/p HPCT | Virus | Days s/p HPCT | Resolved? | Other Therapy for OI | ||||||
| 1 | 65 M | ALL - 1st CR | Sib | 1 × 106 | 99 | EBV-PTLD | 113 | Partial1 | Rituximab | NA | No |
| 2 | 23 M | CML - 2nd CP | Sib | 1 × 106 | 102 | Adeno, CMV | 91, 105 | Yes | Ganciclovir, Cidofovir, IVIg | 21 | No |
| 3 | 53 M | CML - 2nd CP | Sib | 1 × 107 | 64 | CMV | 28 | Yes | Foscarnet + IVIg | 57 | Grade 32 |
| 4 | 61 M | ALL - Ph+-1st CR | Sib | 1 × 107 | 48 | CMV | 26 | Yes | Ganciclovir/valganciclovir, IVIg | 34 | No |
| 5 | 28 M | AML- 1st relapse | Sib | 1 × 107 | 72 | EBV- PTLD | 75 | Yes | Rituximab | 10 | No |
| 6 | 45 M | AML - 2nd relapse | URD | 1 × 106 | 69 | CMV | 24 | Yes | Valganciclovir | NA | No |
HPCT – Hematopoietic Progenitor Cell Transplant; GVHD – Graft-Versus-Host Disease; ALL – acute lymphoblastic leukemia; CML – chronic myelogenous leukemia; AML – acute myelogenous leukemia; CR – complete remission; CP – chronic phase; Ph+ - Philadelphia Chromosone; Sib – HLA identical sibling donor; IRD – unrelated donor; EBV-PTLD – Epstein Barr Virus related Post-Transplant Lymphoproliferative Disease; Adeno – Adenovirus; CMV – cytomegalovirus; OI – Opportunistic Infection; IVIg – Intravenous Immune Globulin
Patient expired from pulmonary and renal complications prior to complete resolution of EBV-PTLD.
This patient had no GVHD following his first dose of LLME DLI (1 × 10e7/kg) but did not achieve a CD4 count >200/ul. He was therefore offered a second dose of DLI (actual dose 4.1 × 10e7/kg) and received it 43 days after the first dose. He subsequently developed Grade III GVHD within a few days of the second DLI administration. The trial was subsequently changed to allow for further DLI only if the CD4 count was < 100/ul.