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