Pre-emptive DLI (pDLI) is an effective strategy in lowering the risk of relapse without significantly increasing the risk of graft-versus-host disease (GVHD) in the case of T cell lineage mixed chimerism (MC) post allogeneic transplant in hematological malignancies. Many patients, however, fail to receive timely pDLI and have dismal outcomes, which are not taken into consideration. We compared long-term outcomes of 106 patients having T cell MC after day 60 and undergoing allogeneic stem cell allograft for acute leukemia from an unrelated donor (UD), with 111 patients having complete chimerism (CC). Fifty-three (56%) patients received prophylactic pDLI. Thirty-six patients (67%) had a response (RR), 17 (33%) had no response (NR), and fifty-two (54%) did not receive any pDLI (ND). OS was better in MC group as compared to CC (54% vs 43%, p = 0.04), mainly due to reduction in NRM (14% vs 25%, p = 0.05), and all grade acute and chronic GVHD. Within the MC group, response to pDLI was the only significant factor predicting OS, DFS, and relapses with NR and ND having unfavorable outcomes as compared to RR (p = 0.001). T cell MC in patients undergoing UD allografts with alemtuzumab is no longer an adverse prognostic factor, as compared to patients having CC, after timely implementation of pDLI.

先发制人的 DLI (pDLI) 是降低复发风险的有效策略，而不会显着增加血液恶性肿瘤同种异体移植后 T 细胞系混合嵌合 (MC) 的移植物抗宿主病 (GVHD) 的风险. 然而，许多患者未能及时接受 pDLI 并且结果令人沮丧，这些都没有被考虑在内。我们比较了 106 名患者在第 60 天后患有 T 细胞 MC 并接受来自无关供体 (UD) 的急性白血病的同种异体干细胞同种异体移植的长期结果，其中 111 名患者患有完全嵌合体 (CC)。53 名 (56%) 患者接受了预防性 pDLI。36 名患者 (67%) 有反应 (RR)，17 名 (33%) 没有反应 (NR)，52 名 (54%) 未接受任何 pDLI (ND)。与 CC 组相比，MC 组的 OS 更好（54% 对 43%，p  = 0.04），主要是由于 NRM 降低（14% 对 25%，p  = 0.05），以及所有级别的急性和慢性 GVHD。在 MC 组中，对 pDLI 的反应是预测 OS、DFS 和复发的唯一重要因素，NR 和 ND 与 RR 相比具有不利的结果（p  = 0.001）。在及时实施 pDLI 后，与患有 CC 的患者相比，接受阿仑单抗同种异体移植的患者的 T 细胞 MC 不再是不良预后因素。