Donor-Lymphocyte Infusion in Patients With Persistent or Recurrent Multiple Myeloma After Allogeneic Hematopoietic Stem Cell Transplantation

The graft-versus-leukemia (GVL) effect of donor-lymphocyte infusions (DLI) is well documented in hematologic malignancies, including multiple myeloma (MM). We evaluated the role of DLI in persistent or recurrent MM after allogeneic hematopoietic stem cell transplantation (allo HCT). We identified 23 patients with MM, who received DLI at UT-MD Anderson Cancer Center between 7/1996 -6/2008. Patients had persistent or recurrent disease after allo HCT, and were treated with DLI collected from their original allo HCT donors. Nineteen patients received DLI from matched related donors (MRD) and 4 from matched unrelated donors (MUD). Median age at DLI was 51 years (range: 38-62). A total of 33 DLI doses were administered. Seventeen patients received 1 infusion, 4 patients received 2, and 2 patient received 4 infusions. Median interval between allo HCT and the first DLI was 8.2 months (range: 2.9 to 119.5). Median follow up from the first DLI was 18 months (range 1-126). Twenty-six DLI (78%) were given without preceding cytoreductive chemotherapy. The median DLI dose was 3.5 x 107 CD3+ T cells (range 0.5 to 14.8 x 107). Overall response rate was 30%, with 10 of 33 DLI doses associated with objective clinical responses (3 CR, 5 VGPR, 2 PR). Thirteen (39%) additional DLI were followed by stable disease. Median response duration was 5 months (range 2-10). ORR to DLI in relapsed disease was 10% (2/20), compared to 61% (8/13) for residual disease (p = 0.0048). Grade II-IV acute graft-versus-host disease (GVHD) was seen in 6 (26%) patients, with median onset of 5 weeks from DLI. None of the patients developed chronic GVHD after DLI. Median overall survival from the first DLI was 18.6 months. DLI is associated with objective clinical responses patients with relapsed or persistent MM, with a significantly higher response rate in patients with persistent vs. relapsed disease. The risk of acute GVHD was low. The role of DLI needs to be further explored in prospective clinical trials for patients with relapsed or persistent MM.