Donor leukocyte infusions for multiple myeloma

Donor leukocyte infusion (DLI) has well-documented activity in CML, but the role of DLI in other diseases is less well defined. To evaluate the strate gy in multiple myeloma (MM) we evaluated 25 MM patients from 15 centers who were treated with DLI, Patients with persistent or recurrent disease after allogeneic BMT received DLI from the original marrow donor (23 matched rel ated, one mismatched family, and one matched unrelated). Chemotherapy was g iven before DLI in three patients, Two of 22 patients responded completely to DLI alone and three patients responded to the combination of DLI and che motherapy. Nine patients who had not had sufficient disease control after D LI were given additional DLIs; five of these patients had either complete ( two) or partial (three) responses. Thirteen of 25 evaluable patients develo ped acute GVHD and 11 of 21 evaluable patients developed chronic GVHD; all responders developed GVHD. No patients developed post-DLI pancytopenia. Fou r patients had responses which lasted >1 year after DLI, three patients had responses which lasted <1 year, and three patients had ongoing responses b ut with followup <1 year. In conclusion, DLI has anti-myeloma activity but the strategy is limited by no response or short duration of response in a s ignificant percentage of patients and by significant GVHD in the majority o f the responders.