Published on October 09, 2026
Long-term Outcome of a DLI-based Treatment Strategy in Patients With Relapsed AML After TCD Allogeneic Stem Cell Transplantation is Hampered by GvHD and Late Relapse
by Alex Kadhim
Two decades of follow-up analysis performed by the Department of Hematology at Leiden University Medical Center, with collaboration from HagaZiekenhuis in The Hague and Medisch Spectrum Twente in Enschede showcase that donor lymphocyte infusion (DLI) cures only a minority of patients whose acute myeloid leukemia (AML) returns following transplant, with disease burden at relapse largely determining which patients benefit. Published in Transplantation and Cellular Therapy, the study demonstrates durable remissions in low-burden relapse, with low survival following high-burden relapse, setting a contemporary benchmark against which newer post-transplant salvage approaches are able to be judged.
Relapse following allogeneic stem cell transplantation (alloSCT) remains the main cause of treatment failure in AML, with DLI driving a graft-versus-leukemia effect that is difficult to separate from graft-versus-host disease (GvHD). This single-center retrospective cohort included 84 adults with relapsed AML following a first alloSCT with in vitro T-cell depletion (TCD) using alemtuzumab, treated between 2005 and 2020 with follow-up through January 2025. Relapse with 10% or fewer bone marrow blasts was treated with DLI alone, and higher-burden relapse received cytoreduction followed by DLI three weeks later, with interferon-alpha added if no GvHD developed. The primary endpoint was 5-year overall survival (OS), with relapse-free survival (RFS), cumulative incidences, and exploratory quality of life as secondary endpoints.
Six patients received supportive care only, leaving 78 treated per protocol. The median time from alloSCT to relapse was 6 months (range 1 to 59). Low-burden relapse (n = 8) reached a 5-year OS of 60% (95% CI, 22 to 98). Among 63 patients with higher-burden relapse given re-induction, 44 (70%) reached DLI, 25 (57%) developed GvHD, and 5-year OS was 7% (95% CI, 1 to 13). Of those reaching DLI, 24 (55%) achieved complete remission, with 2- and 5-year RFS of 35% and 19% and 5-year cumulative relapse and nonrelapse mortality of 25% (95% CI, 12 to 45) and 42% (95% CI, 25 to 51). Transplantation in first remission (hazard ratio 0.40, P = .017) and relapse beyond 6 months (HR 0.44, P = .036) predicted better OS. Severe GvHD in 39% of interferon-alpha recipients led the authors to abandon that combination.
Reference:
Bergsma JE, Argiro EM, Oosterink K, et al. Long-term outcome of a DLI-based treatment strategy in patients with relapsed AML after TCD allogeneic stem cell transplantation is hampered by GvHD and late relapse. Transplant Cell Ther. 2026. https:doi.org/10.1016/j.jtct.2026.08.045
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