Korean J Hematol 2000; 35(1):
Published online March 31, 2000
© The Korean Society of Hematology
자가조혈모세포이식술 후 재발한 Mantle Cell Lymphoma에서 동종조혈모세포이식 및 단계적인 공여자림프구주입술로 완전관해를 획득한 치험례
김동환, 손상균, 정진태, 김기연, 곽동석, 박소향, 이홍기, 이경희, 서장수, 현명수, 박찬형, 이규보
경북대학교 의과대학 내과학교실,
경북대학교 의과대학 임상병리학교실
성균관대학교 의과대학 내과학교실
영남대학교 의과대학 내과학교실
Allogeneic Peripheral Blood Stem Cell Transplantation with Stepwise Donor Lymphocyte Infusions in Mantle Cell Lymphoma Relapsed after Autologous PBSCT
Mantle cell lymphoma (MCL) is distinctive clinicopathologic entity and represents 5-10% of all non-Hodgkin's lymphoma (NHL). The median survival of patients with MCL is only 3 years, and nine of the available conventional chemotherapy regimens appear
curative. Encouraging results have been reported with high dose chemotherapy with stem cell transplantation for its treatment. Particularly, alloSCT appears to induce durable remission via graft-versus-lymphoma (GVL) effect. Donor lymphocyte infusions
(DLIs), by virtue of graft-versus-tumor effect, have been shown to induce remissions in leukemia that recurs after alloSCT. But GVL effect of DLI has not been clearly established in NHL. We describe a patient with relapsed MCL shortly after high dose
chemotherapy with autoSCT who was successfully treated with alloPBSCT. The patient presented with diffuse GI and spleeninvolvement at the time of alloPBSCT. The patient received Bu/Cy/VP-16 as preparative regimen followed by alloPBSCT. the patient
received cyclosporin and methotrexate as GVHD prophylaxis. Prednisone was added after grade II GVHD. The patient had partial response by D+64. To enhance GVL effect, the patient received G-CSF primed DLI serially at D+64 and D+92. Grade iv GVHD
developed 19 days after 2nd DLI and was partially controlled with a combination of cyclosporin, prednisone and mycophenolate mofetil. Clinical complete remission was observed at D+112, and maintained till last follow-up day (D+515). Our findings suggest
that alloSCT and stepwise DLIs may offer a curative approach to MCL.
Keywords Mantle cell lymphoma; Allogeneic stem cell transplantation; Donor lymphocyte infusion; Graft-versus-lymphoma effect;
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Korean J Hematol 2000; 35(1): 72-80
Published online March 31, 2000
Copyright © The Korean Society of Hematology.
자가조혈모세포이식술 후 재발한 Mantle Cell Lymphoma에서 동종조혈모세포이식 및 단계적인 공여자림프구주입술로 완전관해를 획득한 치험례
김동환, 손상균, 정진태, 김기연, 곽동석, 박소향, 이홍기, 이경희, 서장수, 현명수, 박찬형, 이규보
경북대학교 의과대학 내과학교실,
경북대학교 의과대학 임상병리학교실
성균관대학교 의과대학 내과학교실
영남대학교 의과대학 내과학교실
Allogeneic Peripheral Blood Stem Cell Transplantation with Stepwise Donor Lymphocyte Infusions in Mantle Cell Lymphoma Relapsed after Autologous PBSCT
Dong Hwan Kim, Sang Kyun Sohn, Jin Tae Jung, Ki Youn Kim, Dong Seok Kwak, So Hyang Park, Hong Gi Lee, Kyung Hee Lee, Jang Soo Suh, Myung Soo Hyun, Chan Hyung Park, Kyu Bo Lee
Department of Internal Medicine, Clinical Pathology, Kyungpook National University, School of Medicine, Taegu, Korea
Department of Internal Medicine, College of Medicine, Sung Kyun Kwan University, Seoul, Korea
Department of Internal Medicine, Yeungnam University, School Medicine, Taegu, Korea
Abstract
Mantle cell lymphoma (MCL) is distinctive clinicopathologic entity and represents 5-10% of all non-Hodgkin's lymphoma (NHL). The median survival of patients with MCL is only 3 years, and nine of the available conventional chemotherapy regimens appear
curative. Encouraging results have been reported with high dose chemotherapy with stem cell transplantation for its treatment. Particularly, alloSCT appears to induce durable remission via graft-versus-lymphoma (GVL) effect. Donor lymphocyte infusions
(DLIs), by virtue of graft-versus-tumor effect, have been shown to induce remissions in leukemia that recurs after alloSCT. But GVL effect of DLI has not been clearly established in NHL. We describe a patient with relapsed MCL shortly after high dose
chemotherapy with autoSCT who was successfully treated with alloPBSCT. The patient presented with diffuse GI and spleeninvolvement at the time of alloPBSCT. The patient received Bu/Cy/VP-16 as preparative regimen followed by alloPBSCT. the patient
received cyclosporin and methotrexate as GVHD prophylaxis. Prednisone was added after grade II GVHD. The patient had partial response by D+64. To enhance GVL effect, the patient received G-CSF primed DLI serially at D+64 and D+92. Grade iv GVHD
developed 19 days after 2nd DLI and was partially controlled with a combination of cyclosporin, prednisone and mycophenolate mofetil. Clinical complete remission was observed at D+112, and maintained till last follow-up day (D+515). Our findings suggest
that alloSCT and stepwise DLIs may offer a curative approach to MCL.
Keywords: Mantle cell lymphoma, Allogeneic stem cell transplantation, Donor lymphocyte infusion, Graft-versus-lymphoma effect,
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