Patients with post-allogeneic HSCT disease relapse can be treated with salvage chemotherapy but are also candidates for immune suppression withdrawal and/or donor lymphocyte infusion (DLI). A total of 237 adult patients experienced relapse of disease post-allogeneic transplant at our institution between 1995 and 2010. A retrospective institutional analysis was performed on the 52 patients who received DLI in that timeframe. The DLI product infusion doses ranged from 0.07 to 4.0 x 10 8 CD3+

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... . CML patients had the most favorable DLI response rates with 78% (n 5 7) in remission at 3 years. Patients with relapsed AML/ MDS and lymphoid malignancies fared worse with 36% and 21% OS at 3 years respectively. OS was superior in patients in CR prior to DLI (45%) compared to those with active disease (5%) and for patients under the age of 50 (32% vs 21%). Three year OS was observed of 5% for patients who relapsed prior to day +100, 29% for relapse between day +100 and 1 year, and 59% for relapse after 1 year. Patients who developed GvHD prior to relapse had a 3 year OS of 35% vs 9% in patients without GvHD. Patients with post-DLI GvHD had a 39% OS vs 11% for patients without GvHD after DLI. No difference in post-DLI survival was noted with regards to pre-transplant disease status, cell dose or transplant conditioning. CML patients respond well to DLI however in the TKI era, transplants for these patients are reserved for patients with TKI-resistant disease. In other patients, immune suppression withdrawal and DLI have limited efficacy for those who do not achieve CR post-relapse or who relapse within 3 months of transplant. These patients are in need of alternative treatment strategies.