Donor lymphocyte infusions (DLI) are an effective treatment for relapsed chronic myeloid leukemia (CML) after allogeneic stem cell transplantation (alloSCT). Leukemia resistance and secondary graft-versus-host disease (GVHD) are major obstacles to success with DLI. The aim of this study was to identify pre-DLI factors associated with prolonged survival in remission without secondary GVHD. We retrospectively analyzed 500 patients treated with DLI for CML relapse (16% molecular, 30% cytogenetic, and 54% hematological) after alloSCT. The overall probabilities of failure- and secondary GVHD-free survival (FGFS) were 29% and 27% at 5 and 10 years after DLI, respectively. The type of relapse was the major factor influencing FGFS (40% for molecular and/or cytogenetic relapse and 20% for hematological relapse at 5 years, P < .001). Chronic GVHD before DLI and an interval <1 year between alloSCT and first DLI were independently associated with inferior FGFS in patients with molecular and/or cytogenetic relapse. Consequently, FGFS was 13%, 35%, to 56% at 5 years in patients with 2, 1, and 0 adverse features, respectively. In patients with hematological relapse, independent adverse prognostic factors for FGFS were initial dose of CD3<sup>+</sup> cells ≥ 50× 10<sup>6</sup>/kg, donor-recipient sex mismatch, and chronic GVHD before DLI. FGFS was 0%, 17%, 33%, to 37% in patients with 3, 2, 1, and 0 adverse features, respectively. The probability of survival in remission without secondary GVHD was highest (>50% at 5 years) when DLI were given beyond 1 year from alloSCT for molecular and/or cytogenetic CML relapse that was not preceded by chronic GVHD.

Donor lymphocyte infusions for chronic myeloid leukemia relapsing after allogeneic stem cell transplantation. may we predict graft-versus-leukemia without graft-versus-host disease? / Radujkovic, Aleksandar; Guglielmi, Cesare; Bergantini, Stefania; Iacobelli, Simona; van Biezen, Anja; Milojkovic, Dragana; Gratwohl, Alois; Schattenberg, Antonius V. M. B.; Verdonck, Leo F.; Niederwieser, Dietger W.; de Witte, Theo; Kröger, Nicolaus; Olavarria, Eduardo. - In: BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION. - ISSN 1083-8791. - STAMPA. - 21:7(2015), pp. 1230-1236. [10.1016/j.bbmt.2015.03.012]

Donor lymphocyte infusions for chronic myeloid leukemia relapsing after allogeneic stem cell transplantation. may we predict graft-versus-leukemia without graft-versus-host disease?

Guglielmi, Cesare;Bergantini, Stefania;
2015

Abstract

Donor lymphocyte infusions (DLI) are an effective treatment for relapsed chronic myeloid leukemia (CML) after allogeneic stem cell transplantation (alloSCT). Leukemia resistance and secondary graft-versus-host disease (GVHD) are major obstacles to success with DLI. The aim of this study was to identify pre-DLI factors associated with prolonged survival in remission without secondary GVHD. We retrospectively analyzed 500 patients treated with DLI for CML relapse (16% molecular, 30% cytogenetic, and 54% hematological) after alloSCT. The overall probabilities of failure- and secondary GVHD-free survival (FGFS) were 29% and 27% at 5 and 10 years after DLI, respectively. The type of relapse was the major factor influencing FGFS (40% for molecular and/or cytogenetic relapse and 20% for hematological relapse at 5 years, P < .001). Chronic GVHD before DLI and an interval <1 year between alloSCT and first DLI were independently associated with inferior FGFS in patients with molecular and/or cytogenetic relapse. Consequently, FGFS was 13%, 35%, to 56% at 5 years in patients with 2, 1, and 0 adverse features, respectively. In patients with hematological relapse, independent adverse prognostic factors for FGFS were initial dose of CD3+ cells ≥ 50× 106/kg, donor-recipient sex mismatch, and chronic GVHD before DLI. FGFS was 0%, 17%, 33%, to 37% in patients with 3, 2, 1, and 0 adverse features, respectively. The probability of survival in remission without secondary GVHD was highest (>50% at 5 years) when DLI were given beyond 1 year from alloSCT for molecular and/or cytogenetic CML relapse that was not preceded by chronic GVHD.
2015
allogeneic stem cell transplantation; chronic myeloid leukemia; donor lymphocyte infusions; graft-versus-host disease; Graft-versus-leukemia; Relapse; Adolescent; Adult; Child; Child, Preschool; Chromosome Aberrations; Chronic Disease; Female; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Immunosuppressive Agents; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Middle Aged; Myeloablative Agonists; Prognosis; Recurrence; Retrospective Studies; Sex Factors; Siblings; Survival Analysis; Transplantation, Homologous; Unrelated Donors; Graft vs Leukemia Effect; Lymphocyte Transfusion; Transplantation Conditioning; Hematology; Transplantation
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Donor lymphocyte infusions for chronic myeloid leukemia relapsing after allogeneic stem cell transplantation. may we predict graft-versus-leukemia without graft-versus-host disease? / Radujkovic, Aleksandar; Guglielmi, Cesare; Bergantini, Stefania; Iacobelli, Simona; van Biezen, Anja; Milojkovic, Dragana; Gratwohl, Alois; Schattenberg, Antonius V. M. B.; Verdonck, Leo F.; Niederwieser, Dietger W.; de Witte, Theo; Kröger, Nicolaus; Olavarria, Eduardo. - In: BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION. - ISSN 1083-8791. - STAMPA. - 21:7(2015), pp. 1230-1236. [10.1016/j.bbmt.2015.03.012]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1115119
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