A pilot study of prophylactic donor lymphocyte infusions to prevent relapse in adult acute lymphoblastic leukemias after allogeneic hematopoietic stem cell transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 41; no. 9; pp. 805 - 812
• Main Authors: LUTZ, C, MASSENKEIL, G, NAGY, M, NEUBURGER, S, TAMM, I, ROSEN, O, DÖRKEN, B, ARNOLD, R
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.05.2008
• Subjects: Acute Disease; Acute lymphoblastic leukemia; Acute lymphocytic leukemia; Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Care and treatment; Chimerism; Chronic Disease; Complications and side effects; Disease-Free Survival; Female; Follow-Up Studies; Graft versus host disease; Graft vs Host Disease - mortality; Graft vs Host Disease - therapy; Graft vs Leukemia Effect; Graft-versus-host reaction; Graft-versus-leukemia reaction; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Humans; Impact analysis; Leukemia; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Living Donors; Lymphatic leukemia; Lymphocyte Transfusion; Lymphocytes; Male; Medical sciences; Middle Aged; Physiological aspects; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Precursor Cell Lymphoblastic Leukemia-Lymphoma - prevention & control; Recurrence; Remission; Remission Induction; Retrospective Studies; Risk factors; Stem cell transplantation; Stem cells; Survival; Survival Rate; Time Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Chimera; Transplantation, Homologous; Germany; Relapse; Stem cell; Hematopoietic cell; Homograft; Prevention; Lymphoproliferative syndrome; Immunotherapy; Graft; Adult; Acute lymphocytic leukemia; Adoptive immunization; Human; Graft versus leukemia reaction; Immunopathology; Graft versus host disease; Hematology; Donor lymphocyte infusion; mixed chimerism; Malignant hemopathy; Treatment; Donor; Mixed; acute lymphoblastic leukemia; Chimerism; Lymphocyte; graft-versus-host disease; Cancer; graft-versus-leukemia effect
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1705981

The outcome of patients with acute lymphoblastic leukemia (ALL) receiving therapeutic donor lymphocyte infusions (DLIs) in relapse after stem cell transplantation (SCT) is poor. We analyzed the impact of prophylactic DLIs in ALL on chimerism and sustained complete remission (CR). Eighty-five patients with ALL were allografted between January 1998 and September 2004. Twenty-six of them received prophylactic DLIs and were included in this analysis. A total of 12 of 13 patients, who were treated with mixed chimerism (MC) converted to complete donor chimerism (92%) and 10 of 12 patients had persistent donor chimerism and sustained CR during subsequent follow-up. Overall, 18 of 26 patients developed graft-versus-host disease (GVHD) after DLIs (69%), acute GVHD in 46 and chronic GVHD in 62%. After a median follow-up of 42 months (14-72) after SCT, 18 of 26 patients (70%) are alive, 16 in CR. Probability of event-free survival (EFS) for patients treated with DLIs is 62%, and overall survival is 70% at 3 years. Our preliminary data support a graft-versus-leukemia effect of prophylactic DLIs able to induce stable donor chimerism and ongoing CR after SCT. As the accompanying GVHD rate was considerable, careful selection of patients for prophylactic DLIs is mandatory.