1. Donor lymphocyte infusion for prevention of relapse after unmanipulated haploidentical PBSCT for very high-risk hematologic malignancies.
- Author
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Gao XN, Lin J, Wang SH, Huang WR, Li F, Li HH, Chen J, Wang LJ, Gao CJ, Yu L, and Liu DH
- Subjects
- Adolescent, Adult, Allografts, Disease-Free Survival, Female, Graft vs Host Disease etiology, Graft vs Host Disease genetics, Graft vs Host Disease mortality, Humans, Incidence, Leukemia genetics, Leukemia mortality, Lymphoma genetics, Lymphoma mortality, Male, Middle Aged, Mutation, Neoplasm Proteins genetics, Recurrence, Retrospective Studies, Survival Rate, Blood Donors, Graft vs Host Disease prevention & control, Leukemia prevention & control, Lymphocyte Transfusion, Lymphoma prevention & control, Peripheral Blood Stem Cell Transplantation
- 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.- Published
- 2019
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