Donor lymphocyte infusion in the treatment of first Hematological relapse after allogeneic stem-cell transplantation in adults with acute myeloid leukemia:: A retrospective risk factors analysis and comparison with other strategies by the EBMT acute leukemia working party
Donor lymphocyte infusion in the treatment of first Hematological relapse after allogeneic stem-cell transplantation in adults with acute myeloid leukemia:: A retrospective risk factors analysis and comparison with other strategies by the EBMT acute leukemia working party
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DOI：
10.1200/jco.2007.11.6053
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发表时间：
2007-11-01
影响因子：
45.3
通讯作者：
Rocha, Vanderson
中科院分区：
文献类型：
--
作者：
Schmid, Christoph;Labopin, Myriam;Rocha, Vanderson
目的探讨供者淋巴细胞输注（DLI）在异基因造血干细胞移植（HSCT）后复发急性髓系白血病（AML）治疗中的作用。在校正不平衡和确定的危险因素后，比较两组的总生存率。此外，详细分析DLI受体之间的生存危险因素进行了performed.Results中位随访时间分别为27个月和40个月。接受DLI的患者2年时的估计生存率（+/-标准差）为21% +/- 3%，未接受DLI的患者为9% +/- 2%。校正组间差异后，较好的预后与年龄小于37岁（P = 0.008）、HSCT后5个月以上复发（P <0.0001）和使用DLI（P = 0.04）相关。多因素分析显示，DLI接受者中，复发时较低的肿瘤负荷（< 35%的骨髓原始细胞; P = 0.006）、女性（P = 0.02）、良好的细胞遗传学（P = 0.004）和DLI时的缓解（P <0.0001）是生存率的预测因素。两年生存率为56% +/-10%，如果DLI是在缓解或有利的核型，和15% +/- 3%，如果DLI是在再生障碍性贫血或活动性diseases.Conclusion虽然进一步的证据，移植物抗白血病的效果DLI提供，我们的研究结果证实，临床受益仅限于少数患者。应在HSCT后复发性AML成人患者中研究DLI前降低肿瘤负荷的策略以及替代治疗方案。
Purpose To evaluate the role of donor lymphocyte infusion (DLI) in the treatment of relapsed acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (HSCT).Patients and Methods We retrospectively analyzed the data of 399 patients with AML in first hematological relapse after HSCT whose treatment did (n = 171) or did not (n = 228) include DLI. After correction for imbalances and established risk factors, the two groups were compared with respect to overall survival. Further, a detailed analysis of risk factors for survival among DLI recipients was performed.Results Median follow-up was 27 and 40 months, respectively. Estimated survival at 2 years (+/- standard deviation) was 21% +/- 3% for patients receiving DLI and 9% +/- 2% for patients not receiving DLI. After adjustment for differences between the groups, better outcome was associated with age younger than 37 years (P = .008), relapse occurring more than 5 months after HSCT (P < .0001), and use of DLI (P = .04). Among DLI recipients, a lower tumor burden at relapse (< 35% of bone marrow blasts; P = .006), female sex (P = .02), favorable cytogenetics (P = .004), and remission at time of DLI (P < .0001) were predictive for survival in a multivariate analysis. Two-year survival was 56% +/- 10%, if DLI was performed in remission or with favorable karyotype, and 15% +/- 3% if DLI was given in aplasia or with active disease.Conclusion Although further evidence for a graft-versus-leukemia effect by DLI is provided, our results confirm, that the clinical benefit is limited to a minority of patients. Strategies to reduce tumor burden before DLI, as well as alternative treatment options should be investigated in adults with relapsed AML after HSCT.