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Early administration of donor lymphocyte infusions upon molecular relapse after allogeneic hematopoietic stem cell transplantation for chronic myeloid leukemia: a study by the Chronic Malignancies Working Party of the EBMT.
- Source :
-
Haematologica [Haematologica] 2014 Sep; Vol. 99 (9), pp. 1492-8. Date of Electronic Publication: 2014 Jul 04. - Publication Year :
- 2014
-
Abstract
- Patients with chronic myeloid leukemia relapsing after allogeneic hematopoietic stem cell transplantation may be treated by tyrosine kinase inhibitors and/or by donor lymphocyte infusions. The best strategies and timing of administration of lymphocytes are unclear. We analyzed 155 patients who relapsed after allogeneic stem cell transplantation with disease detectable only by molecular methods and who subsequently received lymphocytes. Transplants were performed in first chronic phase (n=125) or in advanced disease (n=29) from identical siblings (n=84) or unrelated donors (n=71) between 1986 and 2003. They received lymphocytes either during molecular relapse (n=85) or upon progression to more advanced disease (1993 to 2004). The median interval from relapse to lymphocyte infusion was 210 (0-1673) days. The median follow up after it was 46 (3-135) months. Overall survival was 76±4% at five years after lymphocyte infusions (89±8% with sibling donors and 63±13% with unrelated donors (P=0.003)). Survival was 69±14% when lymphocytes were given within six months of the detection of molecular relapse and 81±10% (P=0.061) when given later; 81±11% if given at molecular relapse versus 71±12% (P=0.26) with more advanced disease. In multivariate analysis survival was worse if the donor was unrelated (HR 2.54 (95% CI: 1.15-5.53), P=0.021) and better with lymphocyte infusions beyond six months from molecular relapse (HR 0.4 (95%CI: 0.19-0.84), P=0.018). These data confirm the remarkable efficacy of lymphocyte infusions for this disease. There appears to be no advantage from administering it early upon detection of molecular relapse in patients who received allogeneic stem cell transplantation for chronic myeloid leukemia.<br /> (Copyright© Ferrata Storti Foundation.)
- Subjects :
- Disease Progression
Female
Follow-Up Studies
Graft vs Host Disease immunology
Graft vs Host Disease mortality
Graft vs Host Disease pathology
Humans
Leukemia, Myelogenous, Chronic, BCR-ABL Positive immunology
Leukemia, Myelogenous, Chronic, BCR-ABL Positive mortality
Leukemia, Myelogenous, Chronic, BCR-ABL Positive pathology
Male
Neoplasm, Residual immunology
Neoplasm, Residual mortality
Neoplasm, Residual pathology
Recurrence
Siblings
Survival Analysis
Time Factors
Transplantation, Homologous
Unrelated Donors
Graft vs Host Disease therapy
Hematopoietic Stem Cell Transplantation
Leukemia, Myelogenous, Chronic, BCR-ABL Positive therapy
Lymphocyte Transfusion
Neoplasm, Residual therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1592-8721
- Volume :
- 99
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Haematologica
- Publication Type :
- Academic Journal
- Accession number :
- 24997146
- Full Text :
- https://doi.org/10.3324/haematol.2013.100198