Abstract
Donor lymphocyte infusion (DLI) is used to prevent or treat haematological malignancies relapse after allogeneic stem cell transplantation (allo-SCT). Recombinant human granulocyte colony-stimulated factor primed DLI (gDLI) is derived from frozen aliquots of the peripheral blood stem cell collection. We compared the efficacy and safety of gDLI and classical DLI after allo-SCT. We excluded haploidentical allo-SCT. Initial diseases were acute myeloblastic leukaemia (n = 45), myeloma (n = 38), acute lymphoblastic leukaemia (n = 20), non-Hodgkin lymphoma (n = 10), myelodysplasia (n = 8), Hodgkin lymphoma (n = 8), chronic lymphocytic leukaemia (n = 7), chronic myeloid leukaemia (n = 2) and osteomyelofibrosis (n = 1). Indications for DLI were relapse (n = 96) or pre-emptive treatment (n = 43). Sixty-eight patients had classical DLI and 71 had gDLI. The response rate was 38.2%, the 5-year progression-free survival (PFS) rate was 38% (29–48) and the 5-year overall survival (OS) rate was 37% (29–47). Graft versus host disease rate was 46.7% and 10.1% of patients died from toxicity. There were no differences between classical DLI and gDLI in terms of response (p = 0.28), 5-year PFS (p = 0.90), 5-year OS (p. 0.50), GvHD (p = 0.86), treated GvHD (p = 0.81) and cause of mortality (p. 0.14). In conclusion, this study points out no major effectiveness or toxicity of gDLI compared to classical DLI.
Highlights
Donor lymphocyte infusion (DLI) can be used to prevent or cure haematological malignancies relapse after allogeneic stem cell transplantation using the antitumoral effect of donor T cells
Patients with acute myeloid leukaemia (AML), myelodysplasia or acute lymphoid leukaemia (ALL) have a poorer response to DLI and patients with multiple myeloma could benefit from this procedure [2]
DLI was associated with another curative treatment in 34.6% of patients: tyrosine kinase inhibitor for chronic myeloid leukaemia (CML) or ALL (n = 10), hypomethylating agents for myelodysplasia or AML (n = 24), immunomodulatory drug for myeloma (n = 15), anti-CD20 monoclonal antibody for non-Hodgkin lymphoma (n = 1), anti-CD33 or anti-CD30 monoclonal antibody-drug conjugates for AML and Hodgkin lymphoma, respectively (n = 1 each), and JAK2 inhibitor for osteomyelofibrosis (n = 1) or chemotherapy (n = 6)
Summary
Donor lymphocyte infusion (DLI) can be used to prevent or cure haematological malignancies relapse after allogeneic stem cell transplantation (allo-SCT) using the antitumoral effect of donor T cells. The efficacy of DLI is correlated with a low tumour burden [2]. Mixed chimerism and detectable minimal residual disease reflect these low tumour burden situations, preceding clinical relapse and raising the interest of pre-emptive use of DLI in these situations [4]. DLI induces acute and chronic graft versus host disease (GvHD) in 30% and 44%, respectively [5]. This procedure is effective alone or associated with antitumoral chemotherapy or targeted therapy [6,7,8,9]
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