Table 5.
Post-BMT donor cell infusions
| Patient | Donor Cell Infusion Type | DCI Dose | Reason for DCI | Timing of DCI | Chimerism Pre-DCI (% donor) | Chimerism Post-DCI (% donor) | Acute GVHD after DCI | Outcome | ||
|---|---|---|---|---|---|---|---|---|---|---|
| Myeloid | T-cell | Myeloid | T-cell | |||||||
| P3 | Donor-derived tri-virus-specific CTLs | Unknown | CMV infection | +69 | 100% | 100% | 100% | 100% | No | Control of CMV infection |
| P8 | Unconditioned DLI | 5 × 105 CD3+/kg | Slow engraftment | +35 | Whole blood: 50% | 97% | NE | No | Engraftment of neutrophils on day +40, but TRM day +44 | |
| P10 | 3rd party granulocytes | N/A | Planned, during aplasia given active bacterial & fungal infections | +6, +8, +11, +14, +17, +21 | NE | NE | 91% | 98% | Yes, but not related | Unclear benefit - developed cholestasis of sepsis, required abscess drainage, respiratory compromise |
| P12 | Unconditioned DLI Unconditioned DLI |
1 × 106 CD3+/kg 5 × 106 CD3+/kg |
Falling T-cell and myeloid chimerism | +68 +159 |
41% 5% |
0% 0% |
28% 3% |
0% 0% |
No No |
-Brief fevers, abdominal pain – similar but milder to symptoms during initial
engraftment -Very brief fevers, graft loss |
| P13 | Unconditioned DLI | 1 × 105 CD3+/kg | CMV disease – attempt to augment CMV-specific response | +235 | 99% | 98% | 100% | 100% | No | CD8+ T-lymphocytosis with elevated levels of CMV-specific T-cells in the blood. Recovery from CMV pneumonitis. |
| P14 | 2nd BMT& Unconditioned DLI& |
Haplo PBSC graft (same donor) TNC 7.2 × 108/kg CD3+ 7.3 × 107/kg CD34+ 9.2 × 106/kg 5 × 106 CD3+/kg |
Primary graft failure Falling T-cell and myeloid chimerism |
+95 +79 after 2ndBMT |
0% 100% |
0% 40% |
100% 100% |
93% 100% |
No Yes |
Engrafted, but with mixed T-cell chimerism and decreasing blood counts over
time Full donor chimerism, steroid-refractory acute GVHD, grade III, now resolved and off all immunosuppression |
| P15 | Unconditioned DLI Unconditioned DLI |
2 × 106 CD3+/kg 1 × 107 CD3+/kg |
Mixed myeloid and lymphoid chimerism | +227 +304 |
68% 66% |
28% 23% |
69% 63% |
25% 22% |
No No |
Stable chimerism, remained clinically well Stable chimerism, remained clinically well |
Abbreviations: DCI, donor cell infusion; GVHD, graft-versus-host disease; CTL, cytotoxic T-lymphocytes; CMV, cytomegalovirus; DLI, donor lymphocyte infusion; NE, not evaluable (due to insufficient number of cells); TRM, transplant-related mortality; BMT, blood or marrow transplantation; haplo, HLA-haploidentical; PBSC, peripheral blood stem cell
P14 underwent nonemergent second BMT per a published regimen (ref: Klein OR, Chen AR, Gamper C, et al. Alternative-Donor Hematopoietic Stem Cell Transplantation with Post-Transplantation Cyclophosphamide for Nonmalignant Disorders. Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 2016;22:895–901.) after primary graft failure with autologous recovery. He then had threatened secondary graft failure with declining chimerism and blood counts after the second BMT and received an unconditioned DLI post-second BMT with subsequent aGVHD but also achievement of 100% donor chimerism.