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Donor lymphocyte infusion for childhood acute lymphoblastic leukaemia relapsing after bone marrow transplantation
Author(s) -
ATRA A.,
MILLAR B.,
SHEPHERD V.,
SHANKAR A.,
WILSON K.,
TRELEAVEN J.,
PRITCHARDJONES K.,
MELLER S. T.,
PINKERTON C. R.
Publication year - 1997
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1046/j.1365-2141.1997.62650.x
Subject(s) - medicine , bone marrow , donor lymphocyte infusion , transplantation , graft versus host disease , acute lymphocytic leukemia , disease , surgery , leukemia , gastroenterology , lymphoblastic leukemia
Four children with acute lymphoblastic leukaemia (ALL) who relapsed after allogeneic bone marrow transplantation (BMT) were treated with donor lymphocyte infusion (DLI) without prior conditioning. Three patients had previously received a non‐T‐cell‐depleted matched sibling BMT and the fourth had a T‐cell‐depleted matched unrelated BMT. Two patients developed grade III–IV acute graft‐versus‐host‐disease (GVHD) of the skin, which required intervention. Both are alive in complete haematological remission 7 and 10 months from DLI with chronic GVHD of the skin requiring immunosuppressive therapy. A third patient went into haematological remission 6 weeks after DLI, but with no clinical evidence of GVHD. His bone marrow remained in remission 11 months post‐DLI despite the disease (ALL) relapsing in extramedullary sites. The fourth patient showed no clinical or haematological response to three consecutive doses of DLI given at 4‐weekly intervals and died from progressive disease 11 months after relapse. These preliminary observations indicate that in constrast to experience in adult ALL, DLI may be effective in inducing sustained remission in children with ALL relapsing after BMT, and a response may occur even in the absence of clinical evidence of GVHD.