Single‐center experience suggests donor lymphocyte infusion may promote long‐term survival in children with high‐risk acute lymphoblastic leukemia

• Published in: Pediatric blood & cancer 2019-11, Vol.66 (11), p.e27950-n/a
• Main Authors: Liberio, Nicole, Robinson, Haley, Nugent, Melodee, Simpson, Pippa, Margolis, David A., Malarkannan, Subramaniam, Keever‐Taylor, Carolyn, Thakar, Monica S.
• Format: Article
• Language: English
• Subjects: Acute lymphoblastic leukemia; Acute myeloid leukemia; Adolescent; bone marrow transplant; CD19 antigen; CD3 antigen; CD4 antigen; CD56 antigen; CD8 antigen; Child; Children; donor lymphocyte infusion; Female; Follow-Up Studies; Graft vs Leukemia Effect; Graft-versus-host reaction; Hematology; Hematopoietic Stem Cell Transplantation; Humans; immunotherapy; Kaplan-Meier Estimate; Leukemia; Leukemia, Myeloid, Acute - mortality; Leukemia, Myeloid, Acute - therapy; Lymphatic leukemia; Lymphocyte Transfusion; Lymphocytes; Male; Myelodysplastic syndrome; Myelodysplastic Syndromes - therapy; Myelomonocytic leukemia; Oncology; Patients; Pediatrics; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Recurrence; Retrospective Studies; Risk; Salvage Therapy; Statistical analysis; Stem cell transplantation; Survival; Survival Rate; Transplantation; Transplants & implants; Young Adult
• ISSN: 1545-5009; 1545-5017
• DOI: 10.1002/pbc.27950

Background  Donor lymphocyte infusion (DLI) is often used to treat leukemic relapse after hematopoietic cell transplantation (HCT). However, the relationship between outcomes and distinct DLI cellular composition has not been previously reported. Additionally, there are limited published data on efficacy in pediatrics. We evaluated whether DLI cellular content and development of graft‐versus‐host disease (GVHD) impacted disease and influenced overall survival (OS) in children receiving DLI for recurrent leukemia. Methods We performed an Institutional Review Board–approved, retrospective study investigating all consecutive DLIs given to patients at the Children's Hospital of Wisconsin between 1980 and 2018. Analyses were conducted using Mann–Whitney, Fisher exact, and chi‐square tests. Results  Thirty patients ≤20 years old with hematologic malignancies (myeloid [AML/MDS/CML/JMML], n = 23; lymphoid [ALL], n = 7) received DLI to treat post‐transplant relapse. We found no significant difference in OS or development of GVHD based on CD3, CD4, CD8, CD56, or CD19 DLI cellular composition. With a median follow‐up of 0.69 (range, 0.04–16.61) years, OS at five years was 32% ± 9%.  The lymphoid group had a five‐year survival rate at 71% ± 17% compared with the myeloid group at 22% ± 9%, although not statistically significant (P = 0.11).  The development of GVHD did not affect OS (P = 0.62). Conclusion  Here, we report a single‐center, long‐term experience of pediatric DLIs. Surprisingly, many children with ALL were able to achieve durable remissions. Although cellular composition did not have a significant effect on GVHD or OS in our small study, engineering DLI products to maximize specific effector cell populations could be one strategy to improve efficacy.