Donor leukocyte infusion for Japanese patients with relapsed leukemia after allogeneic bone marrow transplantation: lower incidence of acute graft-versus-host disease and improved outcome

To clarify the role of donor leukocyte infusion (DLI) in the treatment of l eukemia relapsing after allo-BMT, data from 100 patients were collected fro m 46 facilities in Japan and analyzed with respect to the efficacy and adve rse effects of donor leukocyte infusion. Complete remission was achieved in 11 of 12 (91%) patients with relapsed chronic myelogenous leukemia (CML) i n chronic phase, three of 11 (27%) with CML in the acute phase, eight of 21 (38%) with acute myelogenous leukemia (AML), six of 23 (25%) with acute ly mphoblastic leukemia (ALL) and five of 11 (45%) with myelodysplastic syndro me (MDS). The probability of remaining in CR at 3 years was 82% in CML pati ents in the chronic phase, but 0% in those with CML in the acute phase, 7% in those with AML, 0% with ALL and 33% with MDS, Acute GVHD (greater than o r equal to 2) developed in 31 of 89 (34%) patients with HLA-identical relat ed donors and was fatal for seven (7%). Cytopenia developed in 21 of 94 (22 %) with no associated fatalities. When the outcome of patients with CML in CP and MDS was analyzed, development of GVHD, cytopenia, or both, was assoc iated with a higher GVL effect (15 of 16, 93%) than in those without advers e affects tone of 6, 17%). A leukocyte dose of 5 x 10(7)/kg of recipient bo dy weight appeared to be optimal as an initial dose of DLI. Given the relat ively low incidence of acute GVHD and the similar GVL effect, DLI may be mo re beneficial to patients in Japan with recurrent leukemia than to those in Western countries.