MANAGEMENT OF LYMPHOMA RECURRENCE AFTER ALLOGENEIC TRANSPLANTATION - THE RELEVANCE OF GRAFT-VERSUS-LYMPHOMA EFFECT

Donor lymphocyte infusions, by virtue of a graft-versus-tumor effect, have been shown to induce remissions in leukemia that recurs after all ogeneic bone marrow transplantation. Similar effects have been postula ted to contribute to the decreased recurrence rate observed after allo geneic transplantation in non-Hodgkin's lymphoma. This lower recurrenc e rate may be due to a variety of other mechanisms. We aimed to evalua te the role of graft-versus-lymphoma effects in patients in whom lymph omas recur after allogeneic transplantation. At the time of recurrence , immunosuppressive therapy was withheld. Patients with non-responding disease received an infusion of donor lymphocytes, Patients were obse rved for response and graft-versus-host disease. Disease in four of ni ne patients responded to withdrawal of immunosuppressive therapy, A mi nor response was observed in one of three recipients of donor lymphocy te infusions, Responses were observed among two patients with follicul ar lymphoma, one with large cell lymphoma and one with lymphoblastic l ymphoma, A minor response was observed in a patient with prolymphocyti c leukemia/lymphoma. We conclude that withdrawal of immunosuppressive therapy and donor lymphocyte infusion can induce durable remissions in patients with recurrent lymphoma after allogeneic transplantation.