Donor leukocyte infusions to treat hematologic malignancy relapse following allo-SCT in a pediatric population

Abstract

Donor leukocyte infusions (DLI) can reverse relapse of hematologic malignancy following allogeneic hematopoietic stem cell transplant (HSCT) in some cases. Little is known regarding the effectiveness of DLI in children who relapse after HSCT. We report outcomes of 49 children who received DLI for relapse after allogeneic transplant. Prognosis was particularly poor (0/14 responses) for patients relapsing within 6 months from transplant. DLI rarely induced remission when given as sole therapy for marrow relapse. One-year disease-free survival was 30% (6/20) in patients who received DLI as consolidation following chemotherapy. The development of GVHD grades 1-2 was associated with superior 3-year survival than patients who developed GVHD grades 3-4 (Po0.002). To determine the benefit of DLI, 45 children who received DLI for relapse (four children without matches were excluded) were compared to 1229 children with similar characteristics whose relapse was not treated with DLI. There was no difference in survival (P ¼ 0.30) once adjustments were made to account for the time from relapse to DLI. Although a few children achieved durable remissions when DLI was used as part of a post-relapse treatment strategy, DLI was unsuccessful in the majority of cases. Strategies may be better directed at preempting post transplant relapse.

Murine allogeneic CD19 CAR T cells harbor potent antileukemic activity but have the potential to mediate lethal GVHD

“…6,7 Furthermore, whereas donor lymphocyte infusion (DLI) can induce remission in myeloid malignancies relapsing following allo-BMT, 8,9 DLI has limited success in ALL even when GVHD occurs. 10 Thus, although GVL has been clearly demonstrated for ALL, improved potency and specificity are needed.…”

New strategies of DLI in the management of relapse of hematological malignancies after allogeneic hematopoietic SCT

“…The T-cell dose used in various studies ranges from 10 4 to 10 8 T cells/kg. [98][99][100] Abhinav et al 101 reviewed the relationship of cell doses used for DLI and response rates in hematological malignancies. The data showed that a cell dose of less than 1 × 10 8 T cells/kg was suboptimal in CML but a cell dose of above 4.5 × 10 8 T cells/kg might lead to more complications, thereby potentially worsening the overall clinical results.…”

Adoptive therapy with donor lymphocyte infusion after allogenic hematopoietic SCT in pediatric patients

“…Levine et al 27 reported a lack of advantage of DLI in children with hematologic malignancy relapse. Better results (26% of disease free survival) were obtained in relapses 46 months after HSCT in contrast to no response to therapy o 6 months from HSCT.…”

“…Better results (26% of disease free survival) were obtained in relapses 46 months after HSCT in contrast to no response to therapy o 6 months from HSCT. 27 Authors pointed at better outcomes in children receiving DLI combined with CT. Those results are compatible with our findings of 39% of positive results of DLI in the REL group, where the majority of children presented later relapses.…”