Lymphodepleting chemotherapy with donor lymphocyte infusion post-allogeneic HCT for hematological malignancies is associated with severe, but therapy-responsive aGvHD.
Bone Marrow Transplant 2016;
51:1107-12. [PMID:
27064686 PMCID:
PMC4972636 DOI:
10.1038/bmt.2016.63]
[Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 02/04/2016] [Accepted: 02/06/2016] [Indexed: 01/02/2023]
Abstract
Donor lymphocyte infusion (DLI) is an option for relapsed hematologic malignancies or incomplete chimerism of non-malignant diseases following allogeneic hematopoietic cell transplantation (HCT). We analyzed the incidence of acute graft versus host disease (aGVHD) in patients treated with DLI. From 1995-2013, 171 DLIs were given to 120 patients. The cumulative incidence of post-DLI grade II-IV aGVHD was 31.6% (CI 25-42%, n=40; 12 grade II); grade III-IV 23.3% (CI 16-32%, n=28). GVHD after DLI (n=46) involved the skin in 70% (n=32), lower gastrointestinal (GI) 65% (n=30), upper GI 43% (n=20), and liver 35% (n=16). Patients receiving chemotherapy accompanying the DLI (chemo-DLI)(n=37) had more frequent aGVHD and particularly lower GI GVHD. Risk factors for grade II-IV aGVHD included: age > 40, chemo-DLI, malignant disease, and time from HCT to DLI < 200 days. aGVHD response to treatment at 8 weeks was complete in 40% and complete/partial (CR/PR) in 52%.
We observed frequent, yet therapy-responsive aGVHD following DLI. Gastrointestinal GVHD in particular is a significant risk when giving chemotherapy prior to DLI. Improvements in DLI efficacy and GVHD management are still needed.
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