Santoro Nicole, Schmid Christoph, de Witte Moniek, Roeven Mieke W H, Potter Victoria, Richardson Deborah, Schroeder Thomas, Válková Veronika, Clesham Katherine, Loron Sandrine, Passweg Jakob, Besley Caroline, Gruhn Bernd, Hoogenboom Jorinde D, Mooyaart Jarl E, Sanchez-Ortega Isabel, Pagliuca Simona, Simonetta Federico, Battipaglia Giorgia, Guillaume Thierry, Hazenberg Mette D, Malard Florent, Kuball Jürgen, Ruggeri Annalisa
Hematology Unit, Department of Oncology and Hematology, Santo Spirito Hospital, Pescara, Italy.
Department of Hematology and Oncology, Augsburg University Hospital and Medical Faculty Comprehensive Cancer Center Augsburg and Bavarian Cancer Research Center, Augsburg, Germany.
Bone Marrow Transplant. 2025 May;60(5):697-701. doi: 10.1038/s41409-025-02555-9. Epub 2025 Mar 23.
Unmanipulated donor lymphocyte infusions (DLI) are crucial for enhancing the graft versus tumor (GVT) effect in post-transplant settings. Practices regarding DLI use vary widely among centers, encompassing differences in indications, prerequisites, and application methods. To explore current DLI policies, we developed a comprehensive survey that garnered responses from 165 EBMT centers across 43 countries. Notably, 97% of respondents reported using DLI in their practices. Indications for DLI included preemptive use for minimal residual disease (MRD) positivity in 86.9% of centers and mixed chimerism in 73.1%; therapeutic use for hematological relapse in 73.1%; and prophylactic use for high-risk disease in 43.8%. Active graft-versus-host disease (GVHD) and active infections were deemed absolute contraindications by 85.6% and 57.5% of centers, respectively. 35% of centers did not consider a prior history of acute (a)GVHD as an exclusion criterion. The majority (71.9%) requested immunosuppression withdrawal before DLI. Most centers (71.3%) collected DLI post-transplant, with 78.1% utilizing unstimulated apheresis. The cell doses applied at the first DLI varied significantly, depending on indication, timing, and donor type. This survey provides the largest overview of current DLI practices, highlighting the need for high-quality data to assess the risks and benefits of different approaches.
未处理的供体淋巴细胞输注（DLI）对于增强移植后环境中的移植物抗肿瘤（GVT）效应至关重要。各中心在DLI使用方面的做法差异很大，包括适应症、前提条件和应用方法的不同。为了探索当前的DLI政策，我们开展了一项全面调查，收集了来自43个国家165个欧洲血液与骨髓移植协会（EBMT）中心的回复。值得注意的是，97%的受访者报告在其实践中使用了DLI。DLI的适应症包括：86.9%的中心对微小残留病（MRD）阳性进行抢先使用，73.1%的中心对混合嵌合体进行使用；73.1%的中心对血液学复发进行治疗性使用；43.8%的中心对高危疾病进行预防性使用。85.6%和57.5%的中心分别将活动性移植物抗宿主病（GVHD）和活动性感染视为绝对禁忌症。35%的中心不将既往急性（a）GVHD病史作为排除标准。大多数（71.9%）中心要求在DLI前停用免疫抑制剂。大多数中心（71.3%）在移植后采集DLI，78.1%的中心使用未刺激的单采术。首次DLI应用的细胞剂量因适应症、时机和供体类型而异。这项调查提供了当前DLI实践的最大概述，强调了需要高质量数据来评估不同方法的风险和益处。
