Canterbury DHB

Context

Post Transplant Donor Lymphocyte Infusions (DLI)

In This Section

Definition of Disease Progression

Guidelines for post-transplant management of patients in the absence of GvHD

DLI Decision-making Guidelines for High Risk Patients without GvHD and off all Immunosuppression

Work-Up Prior to DLI

Doses, Collection and Administration of DLI

Further Reading

Definition of Disease Progression

Disease

Progression

Multiple Myeloma

  • Increasing bone pain or an increase in serum or urine monoclonal protein by 25% and/or serum free light chains.

CLL, NHL, & Hodgkin Lymphoma

  • New sites of lymphadenopathy, or increase of 25% in lymph node size (as assessed by CT scans), or
  • Blood or bone marrow involvement with clonal B cells (lymphoma), or
  • Increase of 25% bone marrow involvement (CLL), or
  • Increase of 25% blood involvement (if lymphocyte count less than 50 x 109/L) with clonal B cells (CLL).

AML/ALL

  • Any evidence of relapse (>5% blasts) by morphologic evaluation of the bone marrow aspirate, or other evidence of relapse.

CML

  • Inability to control granulocyte or platelet counts, or
  • Increase in baseline number of metaphases that demonstrate the Ph+ chromosome by >25%, or rise in BCR/ABL, or
  • Any other new clonal abnormality by cytogenetic evaluation, or
  • Evidence of transformation to accelerated phase or blast crisis.

MDS

  • Any evidence by morphologic evaluation of the bone marrow aspirate of new blasts (>5%), or other evidence of relapse, or
  • Worsening cytopenia attributable to underlying disease.

Guidelines for post-transplant management of patients in the absence of GvHD

DLI Flowchart

(PD: progressive disease, CR: complete remission)

DLI Decision-making Guidelines for High Risk Patients without GvHD and off all Immunosuppression

This is based on chimerism status and disease status on day +56. Management decisions must be taken by day +65.

Chimerism

Disease Status

Action

Full Donor Chimerism

>95% T-cells of donor origin at any time

CR

NONE

Continuing response

Continue to monitor for response and chimerism at monthly intervals

Stable or increasing tumour markers

DLI

Increasing Donor Chimerism

If >50% donor and >20% increase since day +28,

Or

if >80% donor on day +28 and >10% increase in donor cells

ANY

Continue to observe at monthly intervals for progression of chimerism, disease response and GvHD.

Stable Mixed Chimera

Donor engraftment subsequent to day +56 not fulfilling the above definitions

CR/no evidence of disease

DLI

 

Evidence of disease

DLI

ANY Evidence of Disease Activity

Early disease progression (prior to day +56)

Treatment failure

Chemotherapy or DLI as needed

Graft Rejection

ANY

Consider second transplant

Note:

Work-Up Prior to DLI

Doses, Collection and Administration of DLI

Note: Donor-specific DLI harvest schedules and patient-specific DLI infusion schedules are available.

Further Reading

Marks, D. I., et al. (2002). "The toxicity and efficacy of donor lymphocyte infusions given after reduced-intensity conditioning allogeneic stem cell transplantation." Blood 100(9): 3108-3114.

About this Canterbury DHB document (8939):

Document Owner:

Andrew Butler (see Who's Who)

Issue Date:

December 2016

Next Review:

December 2018

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 8939