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Potential clinical benefit of donor lymphocyte infusion in the treatment of refractory invasive fungal pneumonia

Bone Marrow Transplantation volume 40, pages 599–601 (2007)Cite this article

Donor lymphocyte infusion (DLI) may have a potential therapeutic role in allograft recipients with life-threatening opportunistic infections. We report a successful treatment outcome in a patient with invasive fungal pneumonia. The patient who was refractory to prolonged course of liposomal Amphothericin cleared his infection after institution of posaconazole given in conjunction with four sequential DLI. This observed clinical benefit was associated with increasing number of circulating CD4+ and CD8+ T cells post-DLI.

A 66-year-old Caucasian man with history of AML in CR-2 underwent allogeneic peripheral blood SCT from 9/10-matched brother. His myeloablative-conditioning regimen included busulfan, fludarabine, anti-T-lymphocyte globulin (ATG) and high-dose methylprednisolone. A total of 3.44 × 106 CD34+ cells/kg and 3.26 × 108 CD3+ cells/kg were infused during SCT. For GVHD prophylaxis, the patient received tacrolimus and low-dose methotrexate. His myeloid engraftment was completed on day +12. Patient's post-transplantation course was significant for grade II acute GVHD of skin, delayed platelet and red cell engraftment, multiple bacterial infections including a complicated pneumonia. Short tandem repeat (STR) analysis on BM samples on days +35 and +100 showed 100% donor chimerism in both lymphoid and myeloid lineages. His GVHD prophylaxis had been tapered off and discontinued by day +180.

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Authors and Affiliations

  1. Blood and Marrow Transplant Program, Greenebaum Cancer Center, University of Maryland, Baltimore, MD, USA

    C Ilyas & G Akpek

  2. Division of Infectious Disease, Department of Medicine, University of Maryland, Baltimore, MD, USA

    G N Forrest

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  1. C Ilyas
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  2. G N Forrest
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  3. G Akpek
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Correspondence to G Akpek.

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Ilyas, C., Forrest, G. & Akpek, G. Potential clinical benefit of donor lymphocyte infusion in the treatment of refractory invasive fungal pneumonia. Bone Marrow Transplant 40, 599–601 (2007). https://doi.org/10.1038/sj.bmt.1705773

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