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Use of DLI to achieve complete donor chimerism in a patient receiving systemic immunosuppression for refractory AIHA post-NST

Bone Marrow Transplantation volume 36, pages 735–736 (2005)Cite this article

Nonmyeloablative stem cell transplantation (NST) has been evaluated in patients with chronic lymphocytic leukaemia (CLL).1 Such conditioning regimens frequently lead to a state of mixed chimerism in which donor- and host-derived haematopoiesis coexist for a prolonged period post transplant.2 Bethge and co-workers recently reported on their experience of the use of donor lymphocyte infusion (DLI) in 53 of 446 patients who had received transplants from HLA-matched related or unrelated donors after conditioning with 2 Gy total body irradiation (TBI) with or without fludarabine.3 In their protocol, patients were eligible for DLI once all immunosuppression had been discontinued without any flare of graft-versus-host disease (GvHD) for at least 3 weeks. Autoimmune haemolytic anaemia (AIHA) is a common complication of CLL with a reported incidence of 4–40% during the course of the disease.4 Control in severe cases may require protracted systemic immunosuppression.

We report a case of refractory AIHA post-NST for CLL, which necessitated maintenance oral corticosteroids. Due to persistent disease in the context of mixed T-cell chimerism and the absence of GvHD, DLI was administered to the patient who remained on systemic immunosuppression. Conversion to full donor chimerism ensued and disease regression was noted.

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Authors and Affiliations

  1. Department of Haematology, National Centre for Stem Cell Transplantation, St James's Hospital, Dublin, Ireland

    P J Hayden, M Crampe, M Lawler, E Conneally, S R McCann, E Vandenberghe & P V Browne

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  1. P J Hayden
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  2. M Crampe
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  3. M Lawler
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  4. E Conneally
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  5. S R McCann
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  6. E Vandenberghe
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  7. P V Browne
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Hayden, P., Crampe, M., Lawler, M. et al. Use of DLI to achieve complete donor chimerism in a patient receiving systemic immunosuppression for refractory AIHA post-NST. Bone Marrow Transplant 36, 735–736 (2005). https://doi.org/10.1038/sj.bmt.1705116

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