Lymphodepletion chemotherapy followed by donor leukocytes for post-transplantation relapse of myelofibrosis after previous donor leukocyte infusion failure.

Treatment of relapse after allogenic stem cell transplantation (allo-SCT) is challenging. The efficacy of donor leukocyte infusions (DLI) is excellent in chronic phase chronic myeloid leukaemia but limited in other disorders. We present a patient who relapsed 10 months after reduced intensity conditioning allo-SCT for a myelodysplastic/ myeloproliferative neoplasm with myelofibrosis despite receiving escalating doses of DLI for incomplete chimerism. He finally achieved complete remission with full whole blood and T-cell donor chimerism after DLI preceded by lymphodepletion chemotherapy. This case demonstrates that chemotherapy prior to DLI is a useful approach for treating relapses of relatively slowly progressive diseases, such as myeloproliferative diseases or myelodysplastic syndromes.