Clinical Study Of Donor Lymphocyte Infusion In Leukemia Relapse After Allogeneic Hematopoietic Stem Cell Transplantation

Background Disease relapse is still the main cause of mortality after allogeneic hematopoietic cell transplantation. Outcome of morphological relapse patients were usually poor. However, early treatment before florid relapse may improve outcome of certain hematologic malignancies. Persistent high minimal residual disease (MRD) has been shown concordant with disease relapse. However, treatment such as donor lymphocyte infusion (DLI) on account of MRD levels has not been sufficiently studied yet.Methods We retrospectively studied 29 consecutive patients undergone DLI in our hospital from 2005 to 2010. including 18 patients accepting preemptive DLI based on MRD/cytological inspect and 11 receiving DLI for relapsed disease.Results the 3 year overall survival (OS) and relapse free survival (RFS) for all the patients were 63% (95% CI 54～73%) and 57%(95% CI 47～66%), respectively. For 18 preemptive DLI patients,3 year OS and RFS were 89% (95% CI 81～96%) and 83% (95% CI 73～92%), respectively; while 3 year OS and RFS for relapsed patients receiving DLI were only 23% (95% CI 9～36%) and 12% (95% CI 1～23%). respectively. The main cause of mortality in these patients were disease relapse (n=6). acute graft-versus-host disease (n=3) and aplasia (n=1).Conclusion For patients having elevating MRD levels or cvtological blast cell counts. preemptive DLI may significantly improve their long term OS and DFS. without essentially increase treatment related mortality.