Evaluating Donor Lymphocyte Infusion by Relapse Level in MDS

By Ariel Jones - Last Updated: October 7, 2021

For post-transplant disease control in patients with myelodysplastic syndromes (MDS), donor lymphocyte infusion (DLI) has been shown to be an effective option, but its outcomes depend on the induction of antitumor immune reactions, durability of clinical responses, and severity of unwanted toxicities from graft-versus-host disease (GVHD).

In a study published in Therapeutic Advances in Hematology, researchers assessed treatment outcomes among 61 people who received DLI for post-transplant MDS relapse, analyzed according to patients’ level of relapse (hematological, molecular, and imminent relapse).

At two years, the response rates differed according to level of relapse:

  • hematological: 42.1%
  • molecular: 36.4%
  • imminent: 72.7%

Rates of two-year overall survival (OS) were also highest among patients with imminent relapse (70.1%), compared with hematological (27.8%) or molecular (45.5%) relapse.

In the OS analysis, response to DLI or pre-DLI chemotherapy and time to relapse were independent prognostic factors for survival. Post-DLI GVHD and time to relapse were independently predictive for DLI response; however, post-DLI GVHD was predictive for DLI response, but not for OS, “suggesting a potential detrimental impact of GVHD on survival,” the authors noted.

The incidence of GVHD and GVHD-related deaths were 37.7% and 10.0%, respectively. In addition, CD3+ cell doses triggering GVHD tended to be lower in cases with haploidentical donor or imminent relapse.

“This study again demonstrated the therapeutic effects of DLI in relapsed MDS, and that earlier detection and intervention at lower-level relapse might possibly be associated with better results,” the authors wrote. “Furthermore, we propose that tailored cell dosing schedule based on relapse level and donor source may be helpful in minimizing fatal GVHD.”

The authors did acknowledge that the findings of this study are limited by the small number of cases and its retrospective nature.