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Donor lymphocyte infusion for prevention of relapse after unmanipulated haploidentical PBSCT for very high-risk hematologic malignancies.
- Source :
-
Annals of Hematology . Jan2019, Vol. 98 Issue 1, p185-193. 9p. - Publication Year :
- 2019
-
Abstract
- Unmanipulated haploidentical peripheral blood stem cell transplantation (haplo-PBSCT) has been an established treatment to cure high-risk leukemia/lymphoma. Relapse is the main cause of treatment failure for patients with relapsed/refractory disease or with very high-risk gene mutations such as TP53, TET2, and DNMT3a. In this study, we aimed to establish the tolerance and efficacy of prophylactic donor lymphocyte infusion (DLI) with G-CSF-primed peripheral blood progenitors for prevention of relapse in these very high-risk patients after haplo-PBSCT. The prophylactic DLI was given at a median of 77 days after transplantation in 31 of 45 consecutive patients with very high-risk leukemia/lymphoma. The median dose of CD3+ cells for infusion was 1.8 × 107/kg. The 100-day incidences of acute graft-versus-host disease (GVHD) grades 2-4 and 3-4 after DLI were 55.3% and 10.2%. The 2-year incidences of chronic GVHD and severe chronic GVHD were 52.0% and 18.2%. The 2-year incidences of non-relapse mortality and relapse were 33.1% and 32.5%. The 2-year probabilities of overall survival and relapse-free survival were 40.1% and 31.9%. Poor-risk gene mutations (p = 0.029), disease in non-remission status prior to transplantation (p = 0.005), and donors older than 40 years of age (p = 0.043) were associated with relapse after DLI. In multivariate analysis, disease in non-remission status prior to transplantation was an independent risk factor of relapse (hazard ratio = 4.079; p = 0.035). These data showed the feasibility of the prophylactic DLI in the haplo-PBSCT setting and the anti-leukemic efficacy in very high-risk leukemia/lymphoma. [ABSTRACT FROM AUTHOR]
- Subjects :
- *GRAFT versus host disease prevention
*BLOOD donors
*CLINICAL trials
*COMPARATIVE studies
*RED blood cell transfusion
*GRAFT versus host disease
*HEMATOPOIETIC stem cell transplantation
*HOMOGRAFTS
*LEUKEMIA
*LYMPHOMAS
*RESEARCH methodology
*MEDICAL cooperation
*GENETIC mutation
*PROGNOSIS
*PROTEINS
*RESEARCH
*DISEASE relapse
*EVALUATION research
*DISEASE incidence
*RETROSPECTIVE studies
*PREVENTION
Subjects
Details
- Language :
- English
- ISSN :
- 09395555
- Volume :
- 98
- Issue :
- 1
- Database :
- Academic Search Index
- Journal :
- Annals of Hematology
- Publication Type :
- Academic Journal
- Accession number :
- 134163713
- Full Text :
- https://doi.org/10.1007/s00277-018-3482-7