Adoptive therapy with donor lymphocyte infusion after allogenic hematopoietic SCT in pediatric patients
J Gozdzik1, K Rewucka2, A Krasowska-Kwiecien1
11] Department of Clinical Immunology and Transplantation, Polish-American Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland [2] Department of Transplantation, Children's University Hospital in Krakow, Krakow, Poland.
Insights
Donor lymphocyte infusion (DLI) shows efficacy in pediatric patients post-hematopoietic stem cell transplantation, particularly for relapsed disease. While effective in 39% of cases, standardization of this DLI procedure is recommended.
Area of Science:
- Pediatric Hematology
- Immunotherapy
- Stem Cell Transplantation
Background:
- Donor lymphocyte infusion (DLI) is a therapeutic strategy used in hematopoietic stem cell transplantation (HSCT).
- Its application in pediatric patients, especially for managing relapsed or refractory diseases, requires careful evaluation.
- The Polish Pediatric Group for Hematopoietic Stem Cell Transplantation has gathered experience with DLI procedures over two decades.
Purpose of the Study:
- To analyze the experience and outcomes of DLI in pediatric patients undergoing HSCT.
- To evaluate the efficacy and safety of DLI for various indications, including relapse and chimerism enhancement.
- To identify areas for standardization in DLI protocols for children.
Main Methods:
- Retrospective analysis of 51 pediatric patients treated with DLI between 1993 and 2012.
- Patients had malignant or non-malignant diseases post-HSCT.
- DLI was administered at varying doses and schedules, with efficacy assessed based on clinical response and graft status.
Main Results:
- DLI was administered for relapse (28 patients), increasing chimerism (18), and other indications.
- An overall efficacy rate of 39% was observed, with 18 patients achieving complete remission (CR) and 3 partial remission (PR).
- Complications occurred in 18 patients, with 2 treatment-related deaths; graft rejection was noted in 11 patients.
Conclusions:
- Donor lymphocyte infusion is an effective therapy for a significant proportion of pediatric HSCT patients, especially those with relapsed disease.
- The mortality associated with DLI adverse effects is low, suggesting a favorable safety profile.
- Standardization of DLI protocols is crucial to optimize outcomes and minimize risks in pediatric settings.
Abstract:
The aim of this study was to analyse the experience of Polish Pediatric Group for Hematopoietic Stem Cell Transplantation in respect to donor lymphocyte infusion procedure. The study included 51 pediatric patients with malignant (45) and non-malignant (6) diseases treated with DLI in the period 1993-2012. The indications for DLI were as follows: (1) increasing recipient chimerism after non-ablative hematopoietic SCT (18 patients); (2) immunomodulation after a reduced intensity conditioning regimen (2 patients); (3) increase in minimal residual disease detection (3 patients); and (4) relapse (28 patients). DLI was carried out at a median of 6 (0.5-79) months after SCT. DLI was administered as either a single-dose (in 19 cases) or in escalating-dose regimens (in 32 cases). The median total dose of CD3-positive T cells was 28.0 (0.1-730.0) × 10(6)/kg body weight. The time for assessment of DLI efficacy ranged from 0 to 70 (median 3) months. At evaluation, 18 patients experienced CR, 3 achieved PR, 19 showed relapse and 11 rejected the graft. DLI was found to be effective in 39% of cases. Complications of the procedure occurred in 18 patients; of these, 2 died. To sum up DLI shows efficacy in a significant percentage of children. Mortality related to the therapy adverse effects is low. However, this method requires standardization.
More Related Videos
11:18Expanding Cytotoxic T Lymphocytes from Umbilical Cord Blood that Target Cytomegalovirus, Epstein-Barr Virus, and Adenovirus
Published on: May 7, 2012
06:08Assessment of Chimeric Antigen Receptor T Cell-Associated Toxicities Using an Acute Lymphoblastic Leukemia Patient-Derived Xenograft Mouse Model
Published on: February 10, 2023
Related Concept Videos
01:22Bone Marrow Sampling and Transplants
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy...
01:21Stem Cell Therapy for Tissue Regeneration
Types of Stem Cells used in Stem Cell Therapy
The two main cell...