title: Donor leukocyte infusions to treat hematologic malignancy relapse following allo-SCT in a pediatric population.
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.
authors.affiliation: Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109-5941, USA. jelevine@med.umich.edu
authors.forename: J E
authors.initials: JE
authors.lastname: Levine
authors.forename: A J
authors.initials: AJ
authors.lastname: Barrett
authors.forename: M-J
authors.initials: MJ
authors.lastname: Zhang
authors.forename: M
authors.initials: M
authors.lastname: Arora
authors.forename: M A
authors.initials: MA
authors.lastname: Pulsipher
authors.forename: N
authors.initials: N
authors.lastname: Bunin
authors.forename: J
authors.initials: J
authors.lastname: Fort
authors.forename: F
authors.initials: F
authors.lastname: Loberiza
authors.forename: D
authors.initials: D
authors.lastname: Porter
authors.forename: S
authors.initials: S
authors.lastname: Giralt
authors.forename: W
authors.initials: W
authors.lastname: Drobyski
authors.forename: D
authors.initials: D
authors.lastname: Wang
authors.forename: S
authors.initials: S
authors.lastname: Pavletic
authors.forename: O
authors.initials: O
authors.lastname: Ringden
authors.forename: M M
authors.initials: MM
authors.lastname: Horowitz
authors.forename: R
authors.initials: R
authors.lastname: Collins
mesh_terms: D000208:Acute Disease; D002648:Child; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology; D020350:Graft vs Tumor Effect; D019337:Hematologic Neoplasms / Q000601:surgery* / Q000628:therapy*; D006801:Humans; D007938:Leukemia / Q000601:surgery / Q000628:therapy; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000601:surgery / Q000628:therapy; D017708:Leukocyte Transfusion; D008297:Male; D012008:Recurrence; D033581:Stem Cell Transplantation / Q000379:methods*; D014019:Tissue Donors; D014184:Transplantation, Homologous