title: A multicentre UK study of GVHD following DLI: rates of GVHD are high but mortality from GVHD is infrequent.
abstract: DLIs are frequently used following haematopoietic SCT (HSCT) in patients with risk of relapse but data on GVHD following DLI are scarce. We report on 68 patients who received DLI following HSCT. Most patients developed GVHD following DLI (71%), which was acute in 22 patients (32%) almost half of whom had grade III-IV acute GVHD (aGVHD). Thirty patients (44%) developed cGVHD which followed aGVHD in four patients and was graded severe in nine patients. Corticosteroids were the most common first-line therapy for both acute and chronic GVHD. A wide range of second/third-line agents included cyclosporin, mycophenolate, tacrolimus, imatinib, infliximab and ECP. Relapse of initial malignancy occurred in 37%. Relapse was significantly less frequent in those receiving pre-emptive DLI. Relapse rates were also lower in those with GVHD (31%) than those without GVHD (50%), but this did not reach statistical significance. At 55 months post DLI, 34% of patients had died most commonly from relapse and 22% had on-going GVHD. Although GVHD was an important cause of morbidity post DLI (71%), only 6% died from GVHD. Although most patients develop GVHD post DLI and may require consecutive therapies, mortality from GVHD is infrequent. DLI remains an important option for relapse post transplant and manipulation of the GVT effect needs to be optimised to induce remission without morbidity from GVHD.
authors.affiliation: Department Dermatology, University Hospital Birmingham NHS Trust, Birmingham, UK.
authors.forename: J J
authors.initials: JJ
authors.lastname: Scarisbrick
authors.affiliation: Department of Haematology, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: F L
authors.initials: FL
authors.lastname: Dignan
authors.affiliation: Department of Haematology, Nottingham University Hospitals NSH Trust, Nottingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Tulpule
authors.affiliation: Department of Haematology, Nottingham University Hospitals NSH Trust, Nottingham, UK.
authors.forename: E D
authors.initials: ED
authors.lastname: Gupta
authors.affiliation: Department of Haematology, The Royal Marsden NHS Foundation Trust, Surrey, UK.
authors.forename: S
authors.initials: S
authors.lastname: Kolade
authors.affiliation: Department of Haematology, The Royal Marsden NHS Foundation Trust, Surrey, UK.
authors.forename: B
authors.initials: B
authors.lastname: Shaw
authors.affiliation: Department of Statistics, University Hospital Birmingham NHS Trust, Birmingham, UK.
authors.forename: F
authors.initials: F
authors.lastname: Evison
authors.affiliation: Department of Haematology, King's College Hospital, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Shah
authors.affiliation: Department of Haematology, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: E
authors.initials: E
authors.lastname: Tholouli
authors.affiliation: Department of Haematology, King's College Hospital, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Mufti
authors.affiliation: Department of Haematology, King's College Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Pagliuca
authors.affiliation: Department Haematology, University Hospital Birmingham NHS Trust, Birmingham, UK.
authors.forename: R
authors.initials: R
authors.lastname: Malladi
authors.affiliation: Department of Haematology, King's College Hospital, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Raj
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D019520:Living Donors; D017710:Lymphocyte Transfusion; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D007166:Immunosuppressive Agents