Dli after Allogeneic Bmt for Scd

Volume 40, September 2000 TRANSFUSION 1071 Sickle cell disease (SCD) may be associated with considerable morbidity and mortality, particularly as patients reach adulthood.1 Among the various therapeutic options, allogeneic HPC transplantation is the only treatment with proven curative potential.1,2 However, the underlying disease recurs in about 10 percent of patients.2 Donor lymphocyte infusions (DLIs) are increasingly used to treat relapses of malignant diseases after allogeneic HPC transplantations,3-5 inducing a complete remission in about 65 percent of the patients with chronic myelogenous leukemia (CML) and in 20 to 30 percent of the those with acute myelogenous leukemia (AML) or myelodysplastic syndromes.4 Persistence of donor chimerism at the time of DLI was shown to improve the rate of complete remission after DLI6 and to reduce the risk of marrow aplasia,5 which justified early use of DLI in case of unstable chimerism or cytogenetic relapse. Because several observations suggest that both normal and leukemic host-derived HPCs constitute effective target cells for lymphocytes of donor origin,7 we infused donor lymphocytes to a 4-year-old child with evidence of unstable mixed chimerism 8 months after an allogeneic bone marrow for SCD. This observation reports the first successful use of DLI in a patient with probable imminent SCD recurrence after allogeneic HPC transplantation.