Response and toxicity of donor lymphocyte infusions following T-cell depleted non-myeloablative allogeneic hematopoietic SCT from 3-6/6 HLA matched donors

Bone Marrow Transplant. 2009 Feb;43(4):327-33. doi: 10.1038/bmt.2008.321. Epub 2008 Oct 13.


We report the outcome of early donor lymphocyte infusions (DLIs) after T-cell depleted non-myeloablative transplantation using stem cells from HLA-matched or mismatched donors. Sixty-nine patients with high-risk hematologic malignancies received DLI following fludarabine, CY and alemtuzumab with infusion of stem cells from a matched sibling (52) or partially matched family member donor (17). Patients received the first infusion at a median of 50 days after transplant, and doses ranged from 1 x 10(4) CD3+ cells/kg to 3.27 x 10(8) CD3+ cells/kg, depending on clinical status and the physician's discretion. A median cell dose of 1 x 10(5) CD3+ cells/kg in the mismatched setting and 1 x 10(6) CD3+ cells/kg in the matched sibling setting appears safe with only 1 of 7 (14%) and 4 of 31 patients (13%), respectively, experiencing severe acute GVHD at these doses. Importantly, 38% of patients with persistent disease before DLI attained a remission after infusion. Nine of the 69 patients remain alive and disease-free 32-71 months after the first DLI. In conclusion, low doses of DLI can be safely provided soon after T-cell depleted non-myeloablative therapy and provide a chance of remission. However, long-term survival still remains poor, primarily because of relapse in these patients.

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Aged
  • Cohort Studies
  • Graft Survival / immunology
  • Graft vs Host Disease / etiology
  • Graft vs Host Disease / immunology
  • HLA Antigens / immunology
  • Hematologic Neoplasms / immunology
  • Hematologic Neoplasms / therapy*
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Hematopoietic Stem Cell Transplantation / methods*
  • Humans
  • Lymphocyte Transfusion / adverse effects
  • Lymphocyte Transfusion / methods*
  • Middle Aged
  • Myeloablative Agonists / therapeutic use
  • Prospective Studies
  • Survivors
  • T-Lymphocytes / cytology
  • T-Lymphocytes / immunology*
  • Tissue Donors
  • Transplantation Conditioning / methods
  • Treatment Outcome
  • Young Adult


  • HLA Antigens
  • Myeloablative Agonists