Delayed response to donor lymphocyte infusion [DLI] in a relapsed chronic myeloid leukaemia post allogenic bone marrow transplantation

ABSTRACT

Donor lymphocyte infusion [DLI] is nowadays routinely used for inducing remission in patients who relapse into chronic myeloid leukaemia [CML] after allogeneic bone marrow transplantation. In the present case, it took more than 10 months and several DLI along with alpha interferon injection for development of post DLI acute GVHD and remission of the disease. One of the surprising findings was development of accelerated phase like symptoms and blood picture with rising white cell counts, rising basophils, eosinophils and circulating blast cells when the patient developed acute GVHD. Clinically the patient also developed 8 cms enlarged tender splenomegaly at the same time. After a short period of acute GVHD and accelerated phase like blood picture, he entered into clinical and haematological remission with mild persistent chronic GVHD in the skin and mouth. The present case showed that DLI may need to be repeated several times and persistence may often be rewarded