Modified donor lymphocyte infusion-associated acute graft-versus-host disease after haploidentical T-cell-replete hematopoietic stem cell transplantation: incidence and risk factors.

We performed a study to investigate the profile of donor lymphocyte infusion (DLI)-associated acute graft-versus-host disease (GVHD) in haploidentical T-cell-replete hematopoietic stem cell transplantation (HSCT). A total of 124 patients receiving modified DLI after haploidentical T-cell-replete HSCT were enrolled. The cumulative incidence of DLI-associated acute GVHD was 53.2% for grades II-IV and 28.4% for grades III-IV. The duration of GVHD prophylaxis after DLI was the only risk factor for DLI-associated grades III-IV acute GVHD (p<0.05). The cumulative incidence of grades III-IV acute GVHD in patients with prophylaxis more than six, four to six, two to four, and <2 wk were 9.3%, 14.4%, 31.6%, and 49.5%, respectively (p=0.018). Furthermore, DLI-associated grades III-IV acute GVHD was the only risk factor for overall survival (p=0.038, OR=2.869) and transplant-related mortality (p=0.018, OR=3.296) but not a risk factor for relapse after DLI (p=0.840). This study confirms for the first time that the duration of GVHD prophylaxis after DLI is the only risk factor for the development of grades III-IV acute GVHD. Donor lymphocyte infusion with prophylaxis more than six wk was associated with a lower incidence of grades III-IV acute GVHD.