Donor lymphocyte infusion for treatment of relapse of leukemia after HLA-mismatched hematopoietic stem cell transplantation

Objective: To observe the efficacy and safety of donor lymphocyte infusion (DLI) for treatment of leukemia relapse after HLA-mismatched hematopoietic stem cell transplantation (HSCT).

Methods: Patients received DLI were studied for the occurrence of graft-versus-host disease (GVHD) , remission of leukemia and long-term survival after granulocyte colony-stimulating factor (G-CSF). G-CSF-primed DLI and GVHD prophylaxis (some received chemotherapy).

Results: Acute grade III - IV GVHD was observed in 8 of 24 patients relapsed after HSCT and GVHD prophylaxis reduced the incidence (P = 0.013). Eight patients developed chronic GVHD and myelosuppression in three patients. Sixteen of twenty-four patients achieved complete remission. Nine of them survived leukemia-free for a median of 1310 (961 - 1914) days after HSCT. The 1-year and 2-year probability of leukemia-free survival was 60% and 40%, respectively. The number of blasts influenced on remission and survival. Occurrence of extensive chronic GVHD was related to higher remission rate (P = 0.046). All three patients with Ph-positive acute lymphoblastic leukemia died of relapse.

Conclusions: The G-CSF-primed DLI with GVHD prophylaxis(some combined with chemotherapy) is a potentially effective therapeutic option for patients with relapsed leukemia after HLA-mismatched HSCT.