Safety but Limited Efficacy of Donor Lymphocyte Infusion for Post-transplantation Cyclophosphamide-treated Patients

Overview

Journal Bone Marrow Transplant

Specialty General Surgery

Date 2024 Aug 12

PMID 39134710

Authors

Krithika Shanmugasundaram

Scott Napier

Dimana Dimitrova

Anita Stokes

Jennifer Wilder

Amy Chai

Andrea Lisco

Megan V Anderson

Irini Sereti

Gulbu Uzel

Alexandra F Freeman

Christi McKeown

Jennifer Sponaugle

Ruby Sabina

Kamil Rechache

Mustafa A Hyder

Jennifer A Kanakry

Christopher G Kanakry

Affiliations

Soon will be listed here.

Abstract

The therapeutic efficacy of donor lymphocyte infusions (DLIs) given after allogeneic hematopoietic cell transplantation (HCT) is limited by risk of graft-versus-host disease (GVHD). Post-transplantation cyclophosphamide (PTCy) effectively prevents severe GVHD, but there are limited data on outcomes of DLIs given to PTCy-treated patients. We reviewed 162 consecutive PTCy-treated patients transplanted between 2015-2022 within the Center for Immuno-Oncology at the National Cancer Institute. Of 38 DLIs given to 21 patients after 22 HCTs, few DLIs were associated with toxicities of acute GVHD (7.8%), cytokine release syndrome (CRS, 7.8%), or chronic GVHD (2.6%), and all occurred in those receiving serotherapy-containing pre-HCT conditioning (50% of HCTs). Seven DLIs resulted in complete response (18.4%), with 5 of these given after HCTs using serotherapy-containing conditioning. Excluding infectious indications, complete response to DLIs given after transplants with versus without serotherapy-containing pre-HCT conditioning were 30% and 4.3%, respectively. Two patients received DLI for infection and experienced complete resolution without GVHD or CRS, although the efficacy cannot be definitively attributable to the DLI. DLIs given to PTCy-treated patients had low toxicity but limited efficacy, although pre-HCT serotherapy may modulate both toxicity and response. Novel strategies are needed to enhance the therapeutic efficacy of post-transplant cellular therapies without aggravating GVHD.

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