Adoptive Immunotherapy with Donor Lymphocyte Infusion after Allogeneic Nonmyeloablative Stem Cell Transplantation.

Purpose: To explore the efficacy and toxicity of adoptive immunotherapy with donor lymphocyte infusion(DLI) after allogeneic nonmyeloablative stem cell transplantation (allo-NST).

Methods: We retrospectively sum up the clinical data of 28 patients who had been performed with allo-NST among 41 patients and had been treated with DLI for 72 times between October 1999 and October 2004. Among these patients, there are 20 chronic myeloid leukemia (CML), 16 acute leukemia (AL), 2 multiple myeloma (MM) and 3 solid tumor. We used two different preparative regimens with or without Fludarabin. Cyclosporin A and MMF were used in the prevention of graft versus host disease (GVHD). The median dose of DLI was positive CD3 cells 2.7×10⁷/kg (1.0×10⁷/kg–2.0×10⁸/kg). According to the patients’ situation and chimerism, we divided these patients into two groups, one group included 15 patients whose chimerism decreased for the reason of disease relapsed or advanced, the other included 13 patients whose chimerism decreased because of disease remission or stable. We analysis the change of chimerism and patients’ situation after DLI and the side effects of DLI.

Results: Among 28 patients, there are 16 CML, 6 acute myeloid leukemia (AML), 3 acute lymphocytic leukemia (ALL), 1 MM and 2 solid tumor. 13 of them were with increased donor chimerism and 11 of them were with full chimerism. In 11 of the 16 CML patients, whose chimerism decreased because of relapsed or advanced, only one patient who achieved partial remission (PR) and other 10 died for the sake of no effect after DLI. With DLI, 5 patients whose chimerism decreased during the course of disease remission got increasing donor chimerism, 3 got complete remission (CR), 2 got PR, 4 survived and 1 PR patient died of GVHD. Among 6 AML patients with DLI, 1 died due to disease relapsed or advanced and decreased chimerism, other 5 who were with disease remission or stable situation and decreased chimerism obtained CR and survival according to the increased donor chimerism after DLI. Among 3 B-ALL patients post DLI, one alive and the other two died. One MM patient died of no effect. Two late phrase lung cancer patients got PR. One has survived for 14 months and another died of lung virus infection. Their rates of donor chimerism were higher than 80 percent and 96 percent. Among all these 28 patients, their average following up time was 30 months (10–66 months). 12 of them survived (42.6 percent) and total efficient rate was 57.14 percent. 3 developed grade II aGVHD that was DLI-associated. 1 died and 5 was complicated with grade II to IV cGVHD (3 extensive and 2 local). Given active treatment, they were alive. 2 patients had ever been with transient complete blood cell decreasing and had recovered after active surppoting treatment.

Conclusion: DLI is a potential therapy that can make chimerism increase and prevent disease relapse post allo-NST. Its toxicity and side effects can be accepted.