Prevention of relapse using DLI can increase survival following HLA-identical transplantation in patients with advanced-stage acute leukemia: a multi-center study
Prevention of relapse using DLI can increase survival following HLA-identical transplantation in patients with advanced-stage acute leukemia: a multi-center study
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使用 DLI 预防复发可提高晚期急性白血病患者 HLA 相同移植后的生存率：一项多中心研究
DOI：
10.1111/j.1399-0012.2012.01626.x
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发表时间：
2012-07-01
影响因子：
2.1
通讯作者：
Huang, Xiao-Jun
中科院分区：
文献类型：
--
作者：
Wang, Yu;Liu, Dai-Hong;Huang, Xiao-Jun
共分析了123例连续接受hla相同的兄弟姐妹供体移植的晚期急性白血病患者。在血液学复发诊断前，计划在移植后60天内进行g - csf引发的DLI。123人中有50人接受了预防性DLI治疗，73人没有接受预防性治疗。iii级急性移植物抗宿主病（GVHD）的发生率在接受DLI的患者中为17%，在未接受DLI的患者中为23% （p = 0.35）。慢性GVHD的发生率在接受DLI的患者中为38%，在未接受DLI的患者中为17% （p = 0.021）。与未接受预防性DLI的患者（66%）相比，接受预防性DLI的患者2年累积复发率（46%）显著降低（p = 0.02）。接受预防性DLI治疗的患者3年总生存率（36%）高于未接受预防性DLI治疗的患者（11%）（p = 0.001）。接受预防性DLI治疗的患者无白血病生存率（29%）也高于未接受预防性DLI治疗的患者（9%）（p = 0.001）。我们的比较表明，预防性使用DLI可以显著提高晚期急性白血病患者接受相同hla的同胞HSCT的生存率。
A total of 123 consecutive patients with advanced-stage, acute leukemia undergoing HSCT from HLA-identical sibling donors were analyzed. A G-CSF-primed DLI was planned within day 60 post-transplantation before hematologic relapse was diagnosed. Fifty of the 123 individuals received prophylactic DLI, and 73 individuals received no prophylactic treatment. The incidence of grades IIIV acute graft-versus-host disease (GVHD) was 17% for patients receiving DLI and 23% for patients not receiving DLI (p = 0.35). The incidence of chronic GVHD was 38% for patients receiving DLI and 17% for patients not receiving DLI (p = 0.021). The two-yr cumulative incidence of relapse was significantly lower in patients who received prophylactic DLI (46%) compared with patients who did not receive prophylactic DLI (66%) (p = 0.02). The three-yr probability of overall survival was higher in patients who received prophylactic DLI (36%) than in patients who did not receive prophylactic DLI (11%) (p = 0.001). The leukemia-free survival was also higher in patients who received prophylactic DLI (29%) than in patients who did not receive prophylactic DLI (9%) (p = 0.001). Our comparisons suggest that the prophylactic use of DLI can significantly increase survival of patients with advanced-stage, acute leukemia who receive HLA-identical sibling HSCT.