1. ¹Departments of Pediatrics and Internal Medicine, University of Michigan, Ann Arbor, MI, USA
2. ²National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
3. ³Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
4. ⁴Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
5. ⁵Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
6. ⁶Department of Hematology/Oncology, Miami Children's Hospital, Miami, FL, USA
7. ⁷Bone Marrow and Stem Cell Transplant Program, University of Pennsylvania, Philadelphia, PA, USA
8. ⁸Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, TX, USA
9. ⁹Bone Marrow Transplant Program, Medical College of Wisconsin, Milwaukee, WI, USA
10. ¹⁰National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
11. ¹¹Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
12. ¹²Department of Internal Medicine, Hematopoietic Cell Transplantation Program, University of Texas Southwestern Medical Center, Dallas, TX, USA

Correspondence: Dr JE Levine, University of Michigan Health System, 1500 E Medical Center Drive, 5303 Cancer Center, Ann Arbor, MI 48109-5941, USA. E-mail: jelevine@med.umich.edu

Received 17 December 2007; Revised 2 April 2008; Accepted 5 April 2008; Published online 19 May 2008.

Abstract

Donor leukocyte infusions (DLI) can reverse relapse of hematologic malignancy following allogeneic hematopoietic stem cell transplant (HSCT) in some cases. Little is known regarding the effectiveness of DLI in children who relapse after HSCT. We report outcomes of 49 children who received DLI for relapse after allogeneic transplant. Prognosis was particularly poor (0/14 responses) for patients relapsing within 6 months from transplant. DLI rarely induced remission when given as sole therapy for marrow relapse. One-year disease-free survival was 30% (6/20) in patients who received DLI as consolidation following chemotherapy. The development of GVHD grades 1–2 was associated with superior 3-year survival than patients who developed GVHD grades 3–4 (P<0.002). To determine the benefit of DLI, 45 children who received DLI for relapse (four children without matches were excluded) were compared to 1229 children with similar characteristics whose relapse was not treated with DLI. There was no difference in survival (P=0.30) once adjustments were made to account for the time from relapse to DLI. Although a few children achieved durable remissions when DLI was used as part of a post-relapse treatment strategy, DLI was unsuccessful in the majority of cases. Strategies may be better directed at preempting post transplant relapse.