EBMT 2024 | Donor lymphocyte infusion for relapsed myelofibrosis in the post-alloSCT setting
Alex Rampotas, MD, University College London, London, UK, summarizes a talk on the role of donor lymphocyte infusion (DLI) in the post-allogenic stem cell transplant (alloSCT) setting in patients with relapsed myelofibrosis (MF). To date, two retrospective real-world studies have shown that these poor prognosis patients can achieve long-term remission with DLI. Dr Rampotas believes that if prospective studies can answer the questions surrounding the use of this therapeutic approach in the post-transplant setting, DLI has the potential to be a critical tool for improving the outcomes of these patients. This interview took place at the 50th Annual Meeting of the EBMT in Glasgow, Scotland.
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Transcript (edited for clarity)
So in post-transplant relapse setting in myelofibrosis, we have a very challenging situation because the patients actually do quite badly. And at the moment we have many more new treatments that have been approved for myelofibrosis, like fedratinib and momelotinib more recently. However, in the post-transplant setting, there are still open questions. How can we manage those patients?
Donor lymphocyte infusion is a cellular therapy and is a product that can specifically target the malignant clone...
So in post-transplant relapse setting in myelofibrosis, we have a very challenging situation because the patients actually do quite badly. And at the moment we have many more new treatments that have been approved for myelofibrosis, like fedratinib and momelotinib more recently. However, in the post-transplant setting, there are still open questions. How can we manage those patients?
Donor lymphocyte infusion is a cellular therapy and is a product that can specifically target the malignant clone. And actually we think that this should be utilized more. There have been two retrospective real world studies, one that our group has published and one that was published by Hamburg Group. And they have shown that actually patients can achieve long lasting remissions by utilizing donor DLI on the relapse setting.
There are still many questions. For example, do we use it on molecular relapse or when chimerism is falling? Or should we better use it for overt relapse? And one of the problems is that at the moment, we don’t have validated criteria for either relapse or remission in the post-transplant setting. So this causes a lot of problems, but I think its a treatment that can offer a great option for clinicians and patients, respectively. And hopefully we’ll have better studies, prospective studies that would be able to determine how best to use DLI, what dose to use it, if we should be using escalated dose regimen. And I think once all of these questions are answered, DLI would be something in our arsenal that we think should be used a lot more in order to tackle this challenge of relapse at the post-transplant setting for myelofibrosis.
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