G-CSF mobilized vs conventional donor lymphocytes for therapy of relapse or incomplete engraftment after allogeneic hematopoietic transplantation

Abstract

There is little data comparing the activity and toxicity of donor lymphocyte therapy with granulocyte (G)-CSF-mobilized cells (G-donor lymphocyte infusion (DLI)) with the conventionally collected DLI (C-DLI) after allogeneic blood or marrow transplantation. We retrospectively evaluated 67 patients to compare the efficacy and toxicity of GCSF-mobilized DLI with C-DLI in the treatment of relapse of malignant disease or poor donor engraftment post transplant. We assessed clinical outcomes that may represent the immunological outcome of DLI. The median OS was 210 days (range 3-2436 days), 291 days (range 17-1491 days) in the G-DLI group (15 patients) and 207.5 days (range 3-2436 days) in the C-DLI group (52 patients). The median PFS time was 72 days (range 8-1491 days) in the G-DLI group vs 82 days (range 1-2436 days) in the C-DLI group. Rates of post DLI GVHD and improvement in donor engraftment were similar in the G-DLI and C-DLI groups. We conclude that G-DLI appears to have similar therapeutic activity to that seen with C-DLI, and where such cells are available they may be substituted for conventional donor lymphocytes.

Superiority of preemptive donor lymphocyte infusion based on minimal residual disease in acute leukemia patients after allogeneic hematopoietic stem cell transplantation

“…A potent GVL effect was expected in DLI strategy, but it is ideal to control GVHD at a mild level. Many researchers tried to enhance the GVL of infused donor T cells, while decreasing DLI‐related toxicities using new strategies such as granulocyte–colony‐stimulating factor (G‐CSF)‐mobilized peripheral blood progenitor cell infusion or allodepleted donor T cells . We used traditional DLI without G‐CSF stimulation or special depletion in this study, and we also showed a low incidence of severe and lethal aGVHD; most of the mortality was from disease relapse or refractory disease rather than GVHD.…”

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

“…Thus, G-CSF-primed DLI could be a potential approach to treat relapsed leukemia post HSCT; however, in a recent clinical study, G-CSF-primed DLI was not shown to be superior to conventional DLI. 43 Consistent with this study, Curley et al 44 performed a retrospective analysis of 32 relapsed acute leukemia patients after allo-HSCT. Nineteen of them received Flu, Cytarabine and G-CSF (FLAG) induction chemotherapy followed by G-CSF-mobilized DLI and the rest of 13 patients received the same stepwise therapy but no DLI.…”

Preemptive DLI without withdrawal of immunosuppression to promote complete donor T-cell chimerism results in favorable outcomes for high-risk older recipients of alemtuzumab-containing reduced-intensity unrelated donor allogeneic transplant: a prospective phase II trial

“…[12][13][14] Administration of DLI has been shown to promote full-donor chimerism 15 and this may result in lower relapse rates. 14,[29][30][31][32] We postulated that early mixed T-cell chimerism may be effectively converted to full-donor T-cell chimerism by using preemptive low-dose DLI, even in the absence of relapse or persistence of malignancy. We also postulated that continuation, rather than withdrawal of post transplant immunosuppressive therapy, following DLI may minimize the risk of acute GVHD.…”