Escalated Dose Donor Lymphocyte Infusion Treatment in Patients With Primary Immune Deficiencies After Hsct With Reduced-Intensity Conditioning Regimen Publisher Pubmed



Behfar M^{1, 2} ; Mohseni R^{1, 3} ; Salajegheh P¹ ; Kheder M⁴ ; Aboufakher F^{1, 2} ; Nikfetrat Z^{1, 2} ; Jafari F³ ; Naji P³ ; Hamidieh AA¹
Source: Hematology/ Oncology and Stem Cell Therapy Published:2022

Abstract

Objective/Background: Mixed chimerism is a major concern after allogenic hematopoietic stem cell transplantation (HSCT) using a reduced-intensity conditioning (RIC) regimen in primary immunodeficiencies (PIDs). A donor lymphocyte infusion (DLI) escalating dose regimen has been developed with the aim of reducing toxicity while preserving efficacy. However, the graft-versus-host disease (GvHD) development remains the most common and adverse effect of DLI and continues to be a limiting factor in its application, especially nonmalignant diseases such as PIDs. We prospectively evaluated PID patients after HSCT using RIC in Children s Medical Center, who were candidates for an escalating dose of DLI for MC from 2016 to 2018. Methods: With the median follow-up of 16.4 months, 12 patients (nine males and three females) with a median age of 3.72 years received DLI. The median number of DLI was 3.2 (range, 1e5), the maximum and total dose of DLIs administered per patient were 3.6 £ 107 (range, 1e5) cells/kg CD3þ and 9.3 £ 107 (range, 1e15) cells/kg CD3þ cells, respectively. Results: Median donor chimerism at baseline before the DLIs was 41% (range, 11e73%), patients received DLIs at a median of 105 (range, 37e230) days and 52 (range, 3e168) days after the HSCT and onset of the MC, respectively. At the final assessment, six (54.5%) patients improved after DLIs at a median of 47.3 days. Conclusion: PID patients may benefit from DLI with an escalating dose regimen, but the GvHD development remains a concern during the DLI, and the optimum dose and frequency must be standardized. © 2022 King Faisal Specialist Hospital and Research Centre.