HSC donor and recipient experience with post-transplant donor lymphocytes: a single-centre retrospective audit

• Published in: Bone marrow transplantation (Basingstoke) Vol. 43; no. S1; p. S380
• Main Authors: Nicholson, E.K, Clark, A, McQuaker, I.G, Parker, A.N, Douglas, K.W
• Format: Journal Article
• Language: English
• Published: Nature Publishing Group 01.03.2009
• Subjects: Blood donors; Health aspects; Hematopoietic stem cells; Lymphocytes; Methods; United Kingdom
• ISSN: 0268-3369

Objectives: To audit HSC donor and recipient outcomes in relation to post-transplant donor lymphocytes (DL). Patients & methods: DL were collected by apheresis on COBE Spectra. All donations between January 2000 and December 2008 were audited retrospectively via the local transplant data-base. The recipients had AML(n = 5), CML(n = 13), myeloma(n = 5), NHL(n = 3), myelofibrosis(n = 3) or other conditions(n = 8). Results: There were 38 donation requests involving 37 donors (18 females,19 males). One donor was contacted but declined to donate DLI. One donor donated twice for the same recipient. For 1/37 donors no details of donation are available. The median age at time of donation was 43.8 years (Range 12-68 years). There were no failed collection procedures. 6/37 donors experienced mild citrate toxicity. 2/37 donors had a vasovagal episode, but both recovered rapidly and collection was able to be completed.1 donor required central access for DL collection: she had also previously required central access for PBSC donation. A median 1.88 donor blood volumes was processed (range 1.30--2.34). No late donor complications were reported. In total, 36 donors had DL collected. Among the 36 prospective recipients (15 female; 21 male), indications for DL were: mixed chimerism(n = 17); residual disease(n = 3); molecular relapse(n = 10); clinical relapse(n = 2); EBV reactivation(n = 1); pancytopenia of uncertain cause(n = 1); no data(n = 2). 29 of 34 patients for whom data were available (85%) actually received DL infusions. For the remaining 5, reasons for not proceeding were: spontaneous improvement in blood counts; death from EBV; death from relapsed disease; development of GvHD prior to DLI; and spontaneous resolution of mixed chimerism. An escalating-dose regimen was used at 3-monthly intervals depending on response: the median number of doses reinfused was 2 (range 1-5). 9 patients (31%) developed GvHD following DLI. The DLI was successful in treating the stated indication in 18 patients (46%). There were 10 recipient deaths: relapsed disease(n = 4), infection(n = 3), GvHD(n = 2) and progressive EBV(n = 1). Only the two GvHD deaths were considered DL-related. Conclusions: Our single-centre experience confirms that DL are frequently an effective treatment for mixed chimerism or early relapse post-HSC transplant, and that donor experiences are generally good. Although requirement for DL is itself an adverse prognostic factor following HSC transplant, 46% of recipients had a successful outcome.