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Prepublished online as a Blood First Edition Paper on July 5, 2002; DOI 10.1182/blood-2002-02-0506.
Submitted February 14, 2002
Accepted June 10, 2002
The toxicity and efficacy of donor lymphocyte infusions given after reduced intensity conditioning allogeneic stem cell transplantation
David I Marks*, Richard Lush, Jamie Cavenagh, Donald W Milligan, Steven Schey, Anne Parker, Fiona J Clark, Linda Hunt, John Yin, Steven Fuller, Elisabeth Vandenberghe, Judith Marsh, Timothy Littlewood, Graeme M Smith, Dominic Culligan, Ann Hunter, Rajesh Chopra, Andrew Davies, Keiren Towlson, and Catherine D Williams
Adult BMT Unit, Bristol Children's Hospital, Bristol, United Kingdom; British Society of Bone Marrow Transplantation Registry, London, United Kingdom
Nottingham City Hospital, Nottingham, United Kingdom
St. Bartholomew's and Royal London NHS Trust, London, United Kingdom
Birmingham Heartlands Hospital, Birmingham, United Kingdom
Guy's and St. Thomas' NHS Trust, London, United Kingdom
Glasgow Royal Infirmary, Glasgow, United Kingdom
Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
Adult BMT Unit, Bristol Children's Hospital, Bristol, United Kingdom
Manchester Royal Infirmary, Manchester, United Kingdom
Hammersmith Hospital, London, United Kingdom
Royal Hallamshire Hospital Sheffield, Sheffield, United Kingdom
St. George's Hospital London, London, United Kingdom
John Radcliffe Hospital Oxford, Oxford, United Kingdom
Leeds Blood and Marrow Transplant Centre, Leeds, United Kingdom
Aberdeen Royal Infirmary, Aberdeen, United Kingdom
Leicester Royal Infirmary, Leicester, United Kingdom
Christie Hospital Manchester, Manchester, United Kingdom
British Society of Bone Marrow Transplantation Registry, London, United Kingdom
* Corresponding author; email: dmarks{at}nildram.co.uk.
We describe the toxicity and efficacy of DLI given to 81 patients (median 50 years) after RIC transplants performed by 16 UK centres. The diseases treated were NHL (29), CML (12), myeloma (11), AML (10) and CLL (9). Eighty-eight percent received stem cells from sibling donors. The patients received 130 infusions (mean 1.6median 1, range 1-4). Indications for DLI were unsatisfactory response/disease progression (51), mixed chimerism (18), 10 pre-emptive and two other. Graft hypoplasia was uncommon (11%). Grade II-IV GVHD occurred in 23/81 patients (28%) and limited and extensive chronic GVHD in 5/69 and 18/69 evaluable patients (total incidence 33%). Conversion from mixed to full donor chimerism occurred in 19/55 evaluable patients (35%) at a median of 48 days after the DLI; partial responses occurred in 6 patients (total response rate 45%). Eighteen of 51 (35%) patients with measurable disease post-SCT had a CR (2 molecular), and 5 a PR (total response rate 45%). Eleven-seventeenths evaluable complete responders had full donor chimerism. Eight-thirteenths patients with follicular NHL had complete responses and 4/12 patients with CML. Clinical and chimeric responses correlated strongly with acute and chronic GVHD. Forty-seven patients (58%) survive at a median of 508 days post-SCT (range 155-1171 days) with a median Karnofsky score of 90. Thirty-four patients (42%) died at a median of 211 days post transplant with the major causes being progressive disease (26%) and GVHD (9%). Further, systematic studies are required to determine the efficacy and optimum use of DLI for patients with each disease treated with non-myeloablative SCT.
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