Post-transplant lymphoproliferative disease (PTLD), particularly the Epstein–Barr virus-positive (EBV+) type, remains a serious and sometimes fatal complication following hematopoietic stem cell transplantation (HSCT). Standard treatment typically involves reducing immunosuppressive therapy alongside rituximab, but outcomes remain suboptimal for many patients.
A retrospective single-center study published in Frontiers in Oncology examined an alternative therapeutic approach: the use of reduced-dose donor lymphocyte infusion (DLI). In this study, the majority of patients (11 out of 14 in the DLI group) received a DLI with 5 × 10⁴ CD3+ T cells per kg—a dose lower than conventional protocols.
The researchers compared outcomes from a total of 27 patients with EBV+ PTLD who had undergone HSCT, analyzing responses across different treatment regimens. Notably, the reduced-dose DLI group showed a higher rate of complete remission and better 1-year overall survival (OS) than those who received rituximab monotherapy. Additionally, patients receiving reduced-dose DLI experienced fewer instances of acute graft-versus-host disease (GvHD) and lower non-relapse mortality compared to those given conventional-dose DLI.
The findings suggest that both the type of therapy (DLI vs. rituximab) and the dosage of DLI (reduced vs. conventional) may significantly impact outcomes in EBV+ PTLD. However, given the small sample size and retrospective design, further studies are warranted to confirm these results and guide clinical practice.
