Donor lymphocyte infusion after haploidentical hematopoietic stem cell transplantation for acute myeloid leukemia
Donor lymphocyte infusion after haploidentical hematopoietic stem cell transplantation for acute myeloid leukemia
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DOI：
10.1007/s00277-021-04731-5
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发表时间：
2022-01-06
影响因子：
3.5
通讯作者：
Yanada, Masamitsu
中科院分区：
文献类型：
--
作者：
Harada, Kaito;Mizuno, Shohei;Yanada, Masamitsu
尽管单倍体相合供体淋巴细胞输注（DLI）是治疗复发性急性髓系白血病（AML）的有效选择，但移植物抗宿主病（GVHD）的发生率和风险因素以及单倍体相合DLI的疗效尚未得到充分评价。我们使用全国性数据库和额外的问卷调查，回顾性分析了84例AML患者进行单倍体相合DLI后的结局。中位DLI周期数和输注的CD 3（+）细胞剂量分别为1和1.0 × 10（6）/kg。输注的CD 3（+）细胞计数≥ 5.0 × 10（5）/kg与急性GVHD相关（II-IV级，32.1% vs. 10.5%，p = 0.03; III-IV级，21.4% vs. 5.3%，p = 0.10）。发生III-IV级急性GVHD的患者更常死于治疗相关死亡（1年时46.7% vs. 15.8%，p = 0.002），尽管复发相关死亡率显著较低（1年时40.0% vs. 72.2%，p = 0.025）。抢先DLI组（47.4%）对DLI的总体反应显着高于治疗组（13.9%，p = 0.002）。在多变量分析中，抢先DLI是总体反应的预测因素（比值比，5.58; p = 0.003）。我们的研究结果表明，在半相合DLI后，CD 3（+）细胞计数为5.0 × 10（5）/kg或更高的急性GVHD的风险很大，先发制人DLI后的结局良好。
Although haploidentical donor lymphocyte infusion (DLI) is a valid treatment option for relapsed acute myeloid leukemia (AML), the incidence and risk factors for graft-versus-host disease (GVHD) and the efficacy of haploidentical DLI have not been fully evaluated. We retrospectively analyzed the outcomes after haploidentical DLI for 84 patients with AML using a nationwide database and additional questionnaires. The median number of DLI cycles and infused CD3(+) cell dose was 1 and 1.0 x 10(6)/kg, respectively. The infused CD3(+) cell count of 5.0 x 10(5)/kg or higher was associated with acute GVHD (grade II-IV, 32.1% vs. 10.5%, p = 0.03; grade III-IV, 21.4% vs. 5.3%, p = 0.10). Patients who developed grade III-IV acute GVHD more frequently succumbed to treatment-related mortality (46.7% vs. 15.8% at 1 year, p = 0.002), although the relapse-related mortality was significantly low (40.0% vs. 72.2% at 1 year, p = 0.025). The overall response to DLI was significantly higher in the preemptive DLI group (47.4%) than in the therapeutic group (13.9%, p = 0.002). In the multivariate analysis, preemptive DLI was the predictive factor for overall response (odds ratio, 5.58; p = 0.003). Our results indicated the substantial risk of acute GVHD after haploidentical DLI with CD3(+) cell count of 5.0x10(5)/kg or higher and the favorable outcomes after preemptive DLI.