Abstract
Donor lymphocyte infusion (DLI) has the potential to significantly deepen the response after allogeneic stem cell transplantation (ASCT) in multiple myeloma (MM). Subsequently, DLI offers the opportunity for long-term progression-free and, most importantly, overall survival for patients with MM. DLI application is a complex procedure, whereby many factors need to be considered (e.g., patient-oriented factors prior to application, disease-specific factors, as well as possible combinations with further therapies during and after DLI). There are two settings in which DLI can be given, they are as follows: as a salvage option in progressive disease or in the prophylactic setting for MM patients with resolved disease to further deepen the response. While the first studies used DLI in the salvage setting, results for prophylactic DLI appear to be associated with better and prolonged outcomes. Furthermore, DLI (both prophylactic and salvage) given earlier after ASCT (3–6 months) appear to be associated with better outcomes. The incorporation of novel agents showed similar responses and survival after DLI. However, updated and larger evaluations are urgently needed to determine the specific role of multiple variables in such a complex treatment environment of ASCT in an ever-evolving field of MM. This review underlines the rationale for DLI after ASCT, results in the salvage and prophylactic settings, patterns of disease progression after DLI, as well as avenues to further enhance the graft-versus-myeloma effect exerted by DLI.
Highlights
IntroductionPublisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations
This review underlines the rationale for Donor lymphocyte infusion (DLI) after allogeneic stem cell transplantation (ASCT), results in the salvage and prophylactic settings, patterns of disease progression after DLI, as well as avenues to further enhance the graft-versus-myeloma effect exerted by DLI
DLI was mostly given in the context of refractory or progressive disease posttransplant, this modality of immunotherapy has been adopted for and incorporated into the prophylactic post-allogeneic stem cell transplantation (alloSCT) setting for patients with resolved disease
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Alloreactive immune effector cells originating from an MM-free graft may exert graft-versus-myeloma (GVM) effects, which can lead to the long-term control of disease [8]. One immunotherapeutic approach post-alloSCT is donor lymphocyte infusion (DLI), which is believed to augment these GVM effects supporting MM control, by deepening responses [9,10]. DLI may cause graft-versus-host disease (GVHD), which could become life threatening if it is acute, whereas even chronic GVHD may be important for the exertion of GVM effects [11]. We present a comprehensive review of the role and the potential benefits and risks of DLI in post-alloSCT therapy for MM.
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