Donor lymphocyte infusion for prophylaxis and treatment of relapse in pediatric hematologic malignancies after allogeneic hematopoietic stem cell transplant

Sep 29, 2026

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Donor lymphocyte infusion (DLI) can manage post–allogeneic hematopoietic stem cell transplant (HSCT) relapse, yet evidence remains limited for children. This retrospective single-center study evaluated pediatric patients receiving DLI after allogeneic HSCT between 1998 and 2022, analyzing survival and graft-vs-host disease outcomes. Overall survival, event-free survival, and nonrelapse mortality were assessed alongside acute and chronic GVHD, with EFS predicted by pre-HSCT disease status and DLI characteristics.

LanguageEnglish

CategoryHealthcare

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Pages10

Reading Time25 min

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ABSTRACT

Background

Methods

Results

Conclusion

INTRODUCTION

J Chin MedAssoc Original article Donor lymphocyte infusion for prophylaxis and treatment of relapse in pediatric hematologic malignancies after allogeneic hematopoietic stem cell transplant Ming-Hsin Houa,b, Chih-Ying Leea,b,c, Cheng-Yin Hoa,b, Ting-Yen Yud, Giun-Yi Hunga,b,c, Fang-Liang Huange, Tzeon-Jye Chiouf,g,h, Chun-Yu Liug,h, Hsiu-Ju Yena,b,c,* aDivision of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; bSchool of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; cDepartment of Life Science, National Taiwan Normal University, Taipei, Taiwan, ROC; dDepartment of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC; eChildren’s Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; fCancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan, ROC; gDivision of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; hFaculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC ABSTRACT Background: Donor lymphocyte infusion (DLI) is effective for managing patients with hematologic malignancies after allogeneichematopoietic stem cell transplant (HSCT) . However, few studies have explored its optimal use in pediatric populations. Herein, wereport our single-center experiences of DLI and factors for predicting its outcomes. Methods: This retrospective study included pediatric patients who had received DLI (between June 1998 and December 2022) after allogeneic HSCT. Data regarding patient characteristics, preemptive DLI disease status, and DLI characteristics were collected. The primary outcomes were overall survival (OS), event-free survival (EFS), and graft-vs-host-disease (GVHD) development. Results: The study cohort comprised 17 patients with acute leukemia, 3 with chronic leukemia, and 3 with lymphoma. Prophylactic, preemptive, and therapeutic DLI were used in seven, seven, and nine patients, respectively. Patients’ median age and DLI dose were 9 years and 4.6 × 107 CD3+ cells/kg, respectively. The 5-year OS, EFS, and nonrelapse mortality were 43.5%, 38.3%, and 13.3%, respectively. Approximately 39% of the patients developed grade III or IV acute GVHD, whereas moderate/severe chronic GVHD (cGVHD) occurred in 30% of the evaluable patients. Patients’ disease status before HSCT (p = 0.009) and DLI (p = 0.018) were the key factors influencing EFS. The implementation of a dose escalation schedule was associated with a marginal reduction in the risk of moderate/severe cGVHD (p = 0.051) . A DLI dose of ≥5 × 107 CD3+ cells/kg was significantly associated with a high moderate to severe cGVHD risk (p = 0.002) and reduced OS (p = 0.089) . Conclusion: Patients’ disease status before HSCT and DLI may help predict EFS. The use of DLI as a prophylactic and preemptive modality leads to a favorable 5-year EFS. To safely deliver DLI in children, clinicians must maintain vigilant monitoring and prepare patients in advance when escalating the dose to ≥5 × 107 CD3+ cells/kg. Keywords: Donor lymphocyte infusion; Graft vs host disease; Pediatric hematologic malignancy; Posttransplant relapse; Prophylaxis 1. INTRODUCTION Allogenic hematopoietic stem cell transplant (HSCT) is a curative therapy for hematologic malignancies. However, posttransplantation relapse is a major cause of treatment failure. *Address correspondence. Dr. Hsiu-Ju Yen, Department of Pediatrics, Taipei Veterans General Hospital, 201, Shi-Pai Road Section 2, Taipei 112, Taiwan, [ROC. E-mail address: hjyen2@vghtpe.gov.tw](ROC. E-mail address: hjyen2@vghtpe.gov.tw) (H.-J. Yen). Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2023) 86: 991-1000. Received June 20, 2023;

FAQs

What is the purpose of donor lymphocyte infusion (DLI) after allogeneic HSCT in children?

DLI is used to prevent or treat post-HSCT relapse by strengthening graft-vs-leukemia effects. It can be delivered as prophylactic, preemptive, or therapeutic DLI depending on relapse risk and disease status.

What were the main outcomes evaluated in the study?

The study focused on overall survival (OS), event-free survival (EFS), and the development of graft-vs-host disease (GVHD), including acute and chronic GVHD.

Which factors were key predictors of event-free survival (EFS)?

Patients’ disease status before HSCT and DLI were identified as key factors influencing EFS, with statistically significant associations reported.

Sep 29, 2026

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