Adoptive immunotherapy with unselected or EBV-specific T cells for biopsy-proven EBV+ lymphomas after allogeneic hematopoietic cell transplantation

作者：Doubrovina, Ekaterina; Oflaz-Sozmen, Banu; Prockop, Susan E.; Kernan, Nancy A.; Abramson, Sara; Teruya-Feldstein, Julie; Hedvat, Cyrus; Chou, Joanne F.; Heller, Glenn; Barker, Juliet N.; Boulad, Farid; Castro-Malaspina, Hugo; George, Diane; Jakubowski, Ann; Koehne, Guenther; Papadopoulos, Esperanza B.; Scaradavou, Andromachi; Small, Trudy N.; Khalaf, Ramzi; Young, James W.; O'Reilly, Richard J.^*

来源：Blood, 2012, 119(11): 2644-2656.

DOI：10.1182/blood-2011-08-371971

• EPSTEIN-BARR-VIRUS
• BONE-MARROW-TRANSPLANTATION
• VERSUS-HOST-DISEASE
• POSTTRANSPLANTATION LYMPHOPROLIFERATIVE DISORDERS
• POLYMERASE-CHAIN-REACTION
• HIGH-RISK PATIENTS
• CONDITIONING REGIMENS
• DONOR LEUKOCYTES
• LYMPHOCYTES
• GRAFT

We evaluated HLA-compatible donor leukocyte infusions (DLIs) and HLA-compatible or HLA-disparate EBV-specific T cells (EBV-CTLs) in 49 hematopoietic cell transplantation recipients with biopsy-proven EBV-lymphoproliferative disease (EBV-LPD). DLIs and EBV-CTLs each induced durable complete or partial remissions in 73% and 68% of treated patients including 74% and 72% of patients surviving >= 8 days after infusion, respectively. Reversible acute GVHD occurred in recipients of DLIs (17%) but not EBV-CTLs. The probability of complete response was significantly lower among patients with multiorgan involvement. In responders, DLIs and EBV-CTLs regularly induced exponential increases in EBV-specific CTL precursor (EBV-CTLp) frequencies within 7-14 days, with subsequent clearance of EBV viremia and resolution of disease. In nonresponders, EBV-CTLps did not increase and EBV viremia persisted. Treatment failures were correlated with impaired T-cell recognition of tumor targets. Either donor-derived EBV-CTLs that had been sensitized with autologous BLCLs transformed by EBV strain B95.8 could not lyse spontaneous donor-derived EBV-transformed BLCLs expanded from the patient's blood or biopsied tumor or they failed to lyse their targets because they were selectively restricted by HLA alleles not shared by the EBV-LPD. Therefore, either unselected DLIs or EBV-specific CTLs can eradicate both untreated and Rituxan-resistant lymphomatous EBV-LPD, with failures ascribable to impaired T-cell recognition of tumor-associated viral antigens or their presenting HLA alleles. (Blood. 2012;119(11):2644-2656)

• 出版日期2012-3-15