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Safety of pre-emptive donor lymphocyte infusions (DLI) based on mixed chimerism (MC) in peripheral blood or bone marrow subsets in children undergoing hematopoietic stem cell transplant (HSCT) for hematologic malignancies

Bone Marrow Transplantation volume 52, pages 1057–1059 (2017)Cite this article

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Approximately 30–40% of children with acute leukemia relapse after hematopoietic stem cell transplant (HSCT).1 These patients often succumb to disease progression. Infusion of donor lymphocytes (DLI) is a mode of immunotherapy (IT) effective in patients with CML2 and low disease burden.3 However, efficacy of DLI is limited in pediatric acute leukemia. Fewer than 20–30% of patients with relapsed acute leukemia following HSCT achieve remission after DLI.4

Persistent mixed chimerism (MC) is a known predictor of relapse potential. It implies a state of donor tolerance to host Ags.1 Pre-emptive immunotherapy (IT) with fast withdrawal of immunosuppression (FWI) and/or DLI based on MC are strategies to mitigate risk of leukemia relapse. However, it also increases the incidence of GvHD.5, 6, 7 In GvHD, donor T cells mediate an immunogenic response against host cells, causing significant organ damage with consequent host morbidity and mortality.

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Authors and Affiliations

  1. Department of Pediatrics, Benioff Children’s Hospital, University of California, San Francisco, CA, USA

    A Liou

  2. Division of Pediatric Blood and Marrow Transplantation, Benioff Children’s Hospital, University of California, San Francisco, CA, USA

    J T Wahlstrom, C C Dvorak & B N Horn

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  1. A Liou
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  2. J T Wahlstrom
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  3. C C Dvorak
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  4. B N Horn
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Correspondence to A Liou.

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Liou, A., Wahlstrom, J., Dvorak, C. et al. Safety of pre-emptive donor lymphocyte infusions (DLI) based on mixed chimerism (MC) in peripheral blood or bone marrow subsets in children undergoing hematopoietic stem cell transplant (HSCT) for hematologic malignancies. Bone Marrow Transplant 52, 1057–1059 (2017). https://doi.org/10.1038/bmt.2017.45

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