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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 :
- Complementary Index
- Journal :
- Annals of Hematology
- Publication Type :
- Academic Journal
- Accession number :
- 134163713
- Full Text :
- https://doi.org/10.1007/s00277-018-3482-7