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Dasatinib may not suppress the GVL effect of donor lymphocyte infusions for CML

Bone Marrow Transplantation volume 45, pages 395–396 (2010)Cite this article

Donor lymphocyte infusion (DLI) has been considered the standard management for disease relapse after hemopoietic SCT in CML. Responses have been shown to be dose dependent and affected by donor/recipient histocompatibility.1 Disease phase at relapse remains the most important predictor of DLI efficacy and response in the blast phase is typically poor.2 There is some suggestion that imatinib and DLI used together may have a synergistic effect,3 but there is evidence that both imatinib4 and dasatinib5 inhibit the activation and proliferation of normal T lymphocytes in vitro. Dasatinib has been shown to suppress a variety of immune responses in vitro.5, 6, 7, 8 We present here a case of a 32-year-old female with a relapse of CML in myeloid blast crisis who achieved a durable complete molecular remission after dasatinib and DLI used in combination.

It is impossible to establish whether the response in this patient was because of the DLI, dasatinib or both. Sustained responses of blastic phase patients to dasatinib or DLI are rare.9 It is interesting to note that a recent report indicated that dasatinib may reduce the function of regulatory T cells,10 which may affect clinical GVL. More studies are required to establish the role of post-transplant tyrosine kinase inhibitor therapy and to define protocols for the termination of treatment in patients who achieve a sustained remission. In addition, we conclude from this case that dasatinib does not seem to have an antagonistic effect on the GVL-attributable DLI. As has been suggested previously for imatinib,3 there may in fact be a synergistic effect that could be usefully employed to improve outcomes for CML patients who relapse after transplant with advanced phase disease. Further investigation of this potential phenomenon is warranted.

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References

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  1. Department of Haematology, Imperial College London, London, UK

    P Garland, F Dazzi & D Marin

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  1. P Garland
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Correspondence to D Marin.

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Garland, P., Dazzi, F. & Marin, D. Dasatinib may not suppress the GVL effect of donor lymphocyte infusions for CML. Bone Marrow Transplant 45, 395–396 (2010). https://doi.org/10.1038/bmt.2009.136

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