{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T10:02:46Z","timestamp":1790157766620,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Allogeneic hematopoietic stem cell transplantation (alloHSCT) is an essential therapy for several malignant and nonmalignant diseases, but relapse and graft loss remain the principal threats to its success. Routine monitoring of chimerism and minimal residual disease (MRD) enables early detection of imminent recurrence and guides pre\u2010emptive donor lymphocyte infusion (preDLI), which aims to improve or stabilize mixed chimerism (MC) in nonmalignant indications and to exert a graft\u2010versus\u2010leukemia (GvL) effect in malignancies. Pediatric data remain limited and protocols heterogeneous, particularly for nonmalignant disorders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Procedure<\/jats:title>\n                    <jats:p>\n                      This retrospective single\u2010center study analyzed 56 pediatric patients who received preDLI at T\u00fcbingen Children's Hospital between 1998 and 2022 after HLA\u2010matched or single\u2010mismatched alloHSCT. Two primary endpoints were prespecified: the rate of MC stabilization or improvement after preDLI, and the cumulative incidence of de novo graft\u2010versus\u2010host disease (GvHD) attributable to preDLI. Competing risks methodology was applied for graft loss or relapse, non\u2010relapse mortality, and GvHD. Analyses used R version 4.5.1 (\n                      <jats:italic>\u03b1<\/jats:italic>\n                      \u00a0=\u00a00.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Cumulated doses ranged from 25\u00a0\u00d7\u00a010\n                      <jats:sup>3<\/jats:sup>\n                      to 71\u00a0\u00d7\u00a010\n                      <jats:sup>6<\/jats:sup>\n                      cells\/kg, depending on HLA disparity and indication. PreDLI stabilized or improved MC in 65% of nonmalignant (20\/31) and 60% of malignant (15\/25) indications, averting graft loss without re\u2010transplantation in most responders. Treatment was well tolerated; three patients (5.4%) developed de novo GvHD, all Grade I.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PreDLI is a safe and effective intervention in pediatric transplantation, particularly as repeated, escalating doses. We provide practical recommendations, while acknowledging that standardization remains challenging and outcome depends on center experience and indication.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70701","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T09:08:52Z","timestamp":1790154532000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Retrospective Analysis of Donor Lymphocyte Infusions in Pediatric Patients With Mixed Chimerism After Hematopoietic Stem Cell Transplantation"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-1662-2574","authenticated-orcid":false,"given":"Carmen","family":"Junk","sequence":"first","affiliation":[{"name":"Department of General Pediatrics, Oncology and Hematology University Children's Hospital  T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Michaelis","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics, Oncology and Hematology University Children's Hospital  T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michaela","family":"D\u00f6ring","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics, Oncology and Hematology University Children's Hospital  T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9278-1873","authenticated-orcid":false,"given":"Thomas","family":"Eichholz","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics, Oncology and Hematology University Children's Hospital  T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2424-4654","authenticated-orcid":false,"given":"Ursula","family":"Holzer","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics, Oncology and Hematology University Children's Hospital  T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4229-8058","authenticated-orcid":false,"given":"Martin","family":"Ebinger","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics, Oncology and Hematology University Children's Hospital  T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2729-9941","authenticated-orcid":false,"given":"Tim","family":"Flaadt","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics, Oncology and Hematology University Children's Hospital  T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupert","family":"Handgretinger","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics, Oncology and Hematology University Children's Hospital  T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Lang","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics, Oncology and Hematology University Children's Hospital  T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4880-0915","authenticated-orcid":false,"given":"Jan Frederic","family":"Weller","sequence":"additional","affiliation":[{"name":"Medical Clinic Department of Hematology, Oncology, Clinical Immunology and Rheumatology University Hospital T\u00fcbingen  T\u00fcbingen Germany"},{"name":"Department for Oncology Hematology and Bone Marrow Transplantation with the Section of Pneumology University Medical Center Hamburg Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0211-2343","authenticated-orcid":false,"given":"Markus","family":"Mezger","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics, Oncology and Hematology University Children's Hospital  T\u00fcbingen 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H.","year":"2017","journal-title":"Biology of Blood and Marrow Transplantation"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277\u2010023\u201005276\u20105"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41409\u2010022\u201001844\u2010x"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41409\u2010019\u20100580\u20107"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.26141"},{"issue":"5","key":"e_1_2_12_22_1","doi-asserted-by":"crossref","DOI":"10.1111\/petr.14293","article-title":"Post\u2010Transplant Strategies to Improve Relapse\u2010Free Survival in Childhood Leukemia: Whole Blood Donor Lymphocyte Infusions and Lenalidomide for Inducing Graft\u2010Versus\u2010Leukemia Effect","volume":"26","author":"Chandar R.","year":"2022","journal-title":"Pediatric Transplantation"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277\u2010025\u201006662\u2010x"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2017.183012"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2016.63"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2014.10.010"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.23350"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13945"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537\u20102995.2000.40091071.x"},{"issue":"4","key":"e_1_2_12_30_1","first-page":"189","article-title":"Escalated Dose Donor Lymphocyte Infusion Treatment in Patients With Primary Immune Deficiencies after HSCT With Reduced\u2010Intensity Conditioning Regimen","volume":"15","author":"Ali T.","year":"2022","journal-title":"Hematology\/Oncology and Stem Cell Therapy"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24949"},{"key":"e_1_2_12_32_1","doi-asserted-by":"crossref","unstructured":"R.L\u00fcftinger N.Zubarovskaya J.\u2010E.Galimard et al. (2022).Busulfan\u2013fludarabine\u2010 or treosulfan\u2013fludarabine\u2010based myeloablative conditioning for children with thalassemia major. 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