Unmanipulated donor lymphocyte infusions (DLI) are crucial for enhancing the graft versus tumor (GVT) effect in post-transplant settings. Practices regarding DLI use vary widely among centers, encompassing differences in indications, prerequisites, and application methods. To explore current DLI policies, we developed a comprehensive survey that garnered responses from 165 EBMT centers across 43 countries. Notably, 97% of respondents reported using DLI in their practices. Indications for DLI included preemptive use for minimal residual disease (MRD) positivity in 86.9% of centers and mixed chimerism in 73.1%; therapeutic use for hematological relapse in 73.1%; and prophylactic use for high-risk disease in 43.8%. Active graft-versus-host disease (GVHD) and active infections were deemed absolute contraindications by 85.6% and 57.5% of centers, respectively. 35% of centers did not consider a prior history of acute (a)GVHD as an exclusion criterion. The majority (71.9%) requested immunosuppression withdrawal before DLI. Most centers (71.3%) collected DLI post-transplant, with 78.1% utilizing unstimulated apheresis. The cell doses applied at the first DLI varied significantly, depending on indication, timing, and donor type. This survey provides the largest overview of current DLI practices, highlighting the need for high-quality data to assess the risks and benefits of different approaches.

Centre Hospitalier Lyon Sud Lyon France

Department of Hematology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands

Department of Hematology and Center for Translational Immunology UMC Utrecht Utrecht The Netherlands

Department of Hematology and Oncology Augsburg University Hospital and Medical Faculty Comprehensive Cancer Center Augsburg and Bavarian Cancer Research Center Augsburg Germany

Department of Hematology CNRS Nancy University Hospital; UMR 7365 IMoPA Lorraine University Nancy France

Department of Medicine and Clinical Surgery Federico 2 University of Naples Naples Italy

Department of Pediatrics Jena University Hospital Jena Germany

Division of Hematology Department of Oncology Geneva University Hospitals Geneva Switzerland

Division of Hematology Nantes University Hospital; INSERM U1232 CNRS CRCINA Nantes France

EBMT Leiden Study Unit Leiden The Netherlands

EBMT Statistical Unit Leiden The Netherlands

Hematology Unit Department of Oncology and Hematology Santo Spirito Hospital Pescara Italy

Institute of Hematology and Blood Transfusion Prague Czechia

Kings College Hospital London London UK

Radboud University Medical Center Nijmegen Netherlands

San Raffaele Scientific Institute Hematology and Bone Marrow Transplantation Unit Milan Italy

Secretary of the Practice Harmonization and Guidelines Committee of EBMT; EBMT Medical Officer Executive Office Barcelona Spain

Sorbonne Université Centre de Recherche Saint Antoine INSERM UMRs938 Service d'Hématologie Clinique et de Thérapie Cellulaire Hôpital Saint Antoine AP HP Paris France

Southampton General Hospital Southampton UK

University College London Hospital London UK

University Hospital | Basel Basel Switzerland

University Hospital | Essen Duesseldorf Germany

University Hospitals Bristol and Weston NHSFT Bristol UK

University Medical Centre Utrecht The Netherlands

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