Prophylactic donor lymphocyte infusions after first allogeneic hematopoietic stem cell transplantation in children with acute leukemia

다국어 초록 (Multilingual Abstract)

Purpose To evaluate the feasibility and safety of prophylactic donor lymphocyte infusion (DLI) following allogeneic hematopoietic stem cell transplantation (HSCT) to improve survival outcomes in pediatric patients with acute leukemia (AL).
Methods Children with AL who received prophylactic DLI transfusion after allogeneic HSCT between October 2015 and October 2024 were retrospectively analyzed.
Results In total, 101 pediatric patients with AL were enrolled in this study, comprising 42 acute lymphoblastic leukemia, 54 acute myeloid leukemia, and five mixed-phenotype acute leukemia cases. The median age at transplantation was 7.52 ± 3.98 years. The median time from HSCT to first DLI was 306.26 days (range 51.00–1016.00). Patients received a median cumulative dose of 5.00 × 10⁷/kg (0.50–36.20). Post-DLI GVHD occurred in 46.53% of cases. Most events were mild; severe GVHD occurred in only five cases. After prophylactic DLI transfusion, the 5-year overall survival (OS) and event-free survival (EFS) rates were 88.74% ± 3.70% and 79.66% ± 4.92%, respectively. The difference of the OS and EFS in patients with GVHD and without GVHD after prophylactic DLI transfusion were not statistically significant (χ2 = 0.39, P = 0.53 and χ2 = 0.98, P = 0.32). Cumulative DLI dose > 4.75 × 10⁷/kg was associated with favorable prognosis (Area under the curve 0.67, 95% confidence interval 0.50–0.83, P = 0.03).
Conclusion Prophylactic DLI transfusion following allogeneic HSCT remains a safe and effective treatment for pediatric patients with AL and can reduce post-transplant relapse and improve long-term survival.