title: Time to unrelated donor leukocyte infusion is longer, but incidence of GVHD and overall survival are similar for recipients of unrelated DLI compared to matched sibling DLI.
abstract: Donor leukocyte infusion (DLI) is used to treat relapsed leukemia after allogeneic hematopoietic stem cell transplant (HCT). Data comparing outcomes after unrelated DLI (uDLI) to matched sibling DLI (msDLI) are scant. We performed a retrospective analysis to assess differences in time to administer uDLI versus msDLI, and impact on outcomes. Fifty three patients with relapsed acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), or myelodysplastic syndrome (MDS) after allogeneic HCT received uDLI (n = 18) or msDLI (n = 35) from 2000 to 2011. Median time from relapse to uDLI request was 15 days (range 0-66). Median time from relapse to uDLI was 56 days versus 40 days for msDLI patients (p = 0.034). 35% of msDLI and 44% of uDLI patients developed acute GVHD (p = 0.50). There was no significant difference in Grade C/D GVHD among uDLI and msDLI (28% and 21%, p = 0.58) or median OS after DLI between uDLI and msDLI (95 versus 75 days, p = 0.76). For patients with relapsed acute leukemia and MDS after allogeneic HCT, time from relapse to uDLI was longer than to msDLI, but incidence of GVHD and overall survival were similar. Access to uDLI does not appear to be a barrier to DLI administration. Outcomes unfortunately remain poor regardless of donor source.
authors.affiliation: Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Anita J
authors.initials: AJ
authors.lastname: Kumar
authors.affiliation: Merck Pharmaceuticals. Philadelphia, PA USA.
authors.forename: Pavel
authors.initials: P
authors.lastname: Vassilev
authors.affiliation: Division of Hematology/Oncology, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Alison W
authors.initials: AW
authors.lastname: Loren
authors.affiliation: Division of Hematology/Oncology, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Selina M
authors.initials: SM
authors.lastname: Luger
authors.affiliation: Columbia Center for Translational Immunology and Division of Hematology/Oncology, Columbia University Medical Center, New York, New York.
authors.forename: Ran
authors.initials: R
authors.lastname: Reshef
authors.affiliation: Division of Hematology/Oncology, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Saar
authors.initials: S
authors.lastname: Gill
authors.affiliation: Division of Hematology/Oncology, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Smith
authors.affiliation: Department of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Goldstein
authors.affiliation: Division of Hematology/Oncology, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hexner
authors.affiliation: Division of Hematology/Oncology, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Stadtmauer
authors.affiliation: Division of Hematology/Oncology, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David
authors.initials: D
authors.lastname: Porter
authors.affiliation: Division of Hematology/Oncology, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Noelle V
authors.initials: NV
authors.lastname: Frey
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000473:pathology / Q000628:therapy; D017708:Leukocyte Transfusion; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009190:Myelodysplastic Syndromes / Q000401:mortality / Q000473:pathology / Q000628:therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D035781:Siblings; D016019:Survival Analysis; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D061349:Unrelated Donors; D055815:Young Adult