Outcome of donor lymphocyte infusion for fall in chimerism after hematopoietic stem cell transplant

Transpl Immunol. 2020 Aug:61:101305. doi: 10.1016/j.trim.2020.101305. Epub 2020 May 7.

Abstract

Achievement of complete donor chimerism after an allogeneic hematopoietic stem cell transplant is necessary for elimination of underlying malignant disease. A decline in donor chimerism may herald an impending relapse and therefore, early recognition and intervention plays an important role in such cases. A 32 year old male patient diagnosed as a case of Philadelphia positive mixed phenotypic acute leukaemia underwent peripheral blood hematopoietic stem cell transplant (HSCT) with his sibling as donor. During follow-up, a fall in donor chimerism was observed from 91.86% on day +37 to 88.83% on day +57 and 85.34% on day +77. Donor Lymphocyte Infusion (DLI) was harvested via apheresis. A dose of 1 × 106 per kg was infused and the rest was cryopreserved in aliquots of escalating doses. On day +102, he presented with biopsy proven acute mucocutaneous GVHD grade 2 which was managed conservatively and donor chimerism of 57.99%. On day +126, a repeat donor chimerism was performed which showed 100% chimerism. He continues to do well at day +161. Timely use of DLI can improve donor chimerism in patients with Philadelphia positive acute leukaemia who tend to relapse after HSCT.

Keywords: ALL; Chimerism; DLI; HSCT; Philadelphia.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adult
  • Chimerism
  • Graft vs Host Disease / diagnosis*
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Immune Tolerance
  • Immunotherapy, Adoptive
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / diagnosis
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / immunology
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / therapy*
  • Lymphocyte Transfusion / methods*
  • Male
  • Siblings
  • Transplantation Conditioning
  • Transplantation, Homologous
  • Treatment Outcome