DONOR LYMPHOCYTE INFUSION FOR CHILDHOOD ACUTE LYMPHOBLASTIC-LEUKEMIA RELAPSING AFTER BONE-MARROW TRANSPLANTATION

Four children with acute lymphoblastic leukaemia (ALL) who relapsed af ter allogeneic bone marrow transplantation (BMT) were treated with don or lymphocyte infusion (DLI) without prior conditioning. Three patient s had previously received a non-T-cell-depleted matched sibling BMT an d the fourth had a T-cell-depleted matched unrelated BMT. Two patients developed grade III-IV acute graft-versus-host-disease (GVHD) of the skin, which required intervention. Both are alive in complete haematol ogical remission 7 and 10 months from DLI with chronic GVHD of the ski n requiring immunosuppressive therapy. A third patient went into haema tological remission 6 weeks after DLI, but with no clinical evidence o f GVHD. His bone marrow remained in remission 11 months post-DLI despi te the disease (ALL) relapsing in extramedullary sites. The fourth pat ient showed no clinical or haematological response to three consecutiv e doses of DLI given at 4-weekly intervals and died from progressive d isease 11 months after relapse. These preliminary observations indicat e that in constrast to experience in adult ALL, DLI may be effective i n inducing sustained remission in children with ALL relapsing after BM T, and a response may occur even in the absence of clinical evidence o f GVHD.