Although the feasibility of using HLA-mismatched unrelated donors as an alternate graft source for haematopoietic SCT (HSCT) has been shown, little is known about the safety of HLA-mismatched DLI for the treatment of relapse. We examined the outcome of 58 consecutive leukaemia patients who received escalating-dose DLI for treatment of relapse after alemtuzumab-conditioned myeloablative unrelated donor HSCT at our institution. High-resolution HLA typing on stored DNA samples revealed mismatches in 28/58 patients who were considered HLA-matched at the time of transplantation. Following DLI from HLA-matched (10/10) (n=30) or -mismatched (7-9/10) (n=28) unrelated donors, we found no significant difference in the incidence of acute GVHD (17.2% versus 23.1%, P=0.59), probability of remission at 3 years (62.1% versus 63.9%, P=0.89) or 5-year OS (89.8% versus 77.7%, P=0.22). We conclude that escalating-dose DLI can be safely given to HLA-mismatched recipients following T-depleted myeloablative HSCT.
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This work was supported by Leuka (registered charity number 286231) and the National Institute for Health Research (NIHR) Biomedical Research Centre.
AI performed data collection, analysed the data and wrote the paper; RB performed research and analysed the data; RS provided reagents and analysed the data; GD analysed the data and contributed to writing the paper; LF and EB provided sample material and contributed to the paper; DM and SM analysed the data and contributed to writing the paper, D, MM, EK, JP, AR, IR, JG, JA and FD provided patient care, and contributed to writing of the paper; RS analysed the data and wrote the paper; KR designed and supervised the research, analysed the data and wrote the paper.
Dr John Goldman is Editor in Chief of Bone Marrow Transplantation. The remaining authors declare no conflict of interest.
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Innes, A., Beattie, R., Sergeant, R. et al. Escalating-dose HLA-mismatched DLI is safe for the treatment of leukaemia relapse following alemtuzumab-based myeloablative allo-SCT. Bone Marrow Transplant 48, 1324–1328 (2013) doi:10.1038/bmt.2013.69
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