Donor lymphocyte infusion to eradicate recurrent host hematopoiesis after allogeneic BMT for sickle cell disease

BACKGROUND: Donor lymphocyte infusion (DLI) is currently standard therapy f or relapse of malignancies after allogeneic BMT. Several observations sugge st that both normal and leukemic progenitor cells of host origin constitute effective target cells for donor-derived lymphocytes. To prevent relapse o f sickle cell disease (SCD), a child with evidence of decreasing mixed chim erism received DLIs 8 months after allogeneic BMT for SCD. CASE REPORT: A 4-year-old child who was homozygous for SCD underwent a tran splantation of bone marrow from his fully HLA-matched sister. Routine detec tion of sex chromosomes in bone marrow cells evidenced decreasing mixed chi merism, which heralded a probably imminent recurrence of the disease. The p atient received two DLIs in graded incremental doses on Days 234 and 267. O ne month later, he developed grade 2 acute GVHD that responded well to cort icosteroids and cyclosporine. RESULTS: DLI resulted in complete donor chimerism within 2 months of the se cond infusion. Now, 2 years after the second DLI, the patient is in excelle nt condition, with normal Hb and excellent growth and development. CONCLUSION: This is the first report of successful use of DLI in a patient with probable imminent SCD recurrence after allogeneic BMT. It shows that D LI can displace residual host HPCs in case of recurrence of non- malignant disease after allogeneic BMT.