[en] We report on 318 patients with acute leukemia, receiving donor lymphocyte infusion (DLI) in complete hematologic remission (CHR) after allogeneic stem cell transplantation (alloSCT). DLI were applied preemptively (preDLI) for minimal residual disease (MRD, n = 23) or mixed chimerism (MC, n = 169), or as prophylaxis in high-risk patients with complete chimerism and molecular remission (proDLI, n = 126). Median interval from alloSCT to DLI1 was 176 days, median follow-up was 7.0 years. Five-year cumulative relapse incidence (CRI), non-relapse mortality (NRM), leukemia-free and overall survival (LFS/OS) of the entire cohort were 29.1%, 12.7%, 58.2%, and 64.3%. Cumulative incidences of acute graft-versus-host disease (aGvHD) grade II-IV°/chronic GvHD were 11.9%/31%. Nineteen patients (6%) died from DLI-induced GvHD. Age ≥60 years (p = 0.046), advanced stage at transplantation (p = 0.003), shorter interval from transplantation (p = 0.018), and prior aGvHD ≥II° (p = 0.036) were risk factors for DLI-induced GvHD. GvHD did not influence CRI, but was associated with NRM and lower LFS/OS. Efficacy of preDLI was demonstrated by decreasing MRD/increasing blood counts in 71%, and increasing chimerism in 70%. Five-year OS after preDLI for MRD/MC was 51%/68% among responders, and 37% among non-responders. The study describes response and outcome of DLI in CHR and helps to identify candidates without increased risk of severe GvHD.
Disciplines :
Hematology
Author, co-author :
Schmid, Christoph ; Department of Hematology and Oncology, Augsburg University Hospital and Medical Faculty, Augsburg, Germany. Christoph.Schmid@uk-augsburg.de
Labopin, Myriam ; EBMT Study Office, Saint Antoine Hospital, Paris, France ; INSERM UMR 938, Sorbonne University, Paris, France
Schaap, Nicolaas; Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
Veelken, Hendrik ; Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
Brecht, Arne; Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
Stadler, Michael; Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
Finke, Juergen; Department of Hematology and Medical Oncology, University of Freiburg, Freiburg, Germany
Baron, Frédéric ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'hématologie clinique
Collin, Matthew ; Bone Marrow Transplant Unit, Northern Centre for Bone Marrow Transplantation, Newcastle-upon-Tyne, UK
Bug, Gesine; Department of Medicine 2, Goethe University Frankfurt, Frankfurt am Main, Germany
Ljungman, Per ; Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
Blaise, Didier ; Programme de Transplantation & Therapie Cellulaire-Centre de Recherche en Cancérologie de Marseille-Institut Paoli Calmettes, Marseille, France
Tischer, Johanna; Department of Medicine 3, Hematology and Oncology, Ludwig-Maximilian-University, Munich, Germany
Bloor, Adrian ; Stem Cell Transplantation Unit, The Christie NHS Foundation Trust, Manchester, UK
Kulagin, Aleksander ; RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
Giebel, Sebastian ; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland
Gorin, Norbert-Claude; Faculté de Médicine Saint-Antoine and EBM study office, Saint Antoine Hospital, Paris, France
Esteve, Jordi ; Hospital Clinic Barcelona, Institute of Hematology and Oncology, Barcelona, Spain
Ciceri, Fabio ; Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milano, Italy
Savani, Bipin ; Vanderbilt University Medical Center, Nashville, TN, USA
Nagler, Arnon; BMT and Cord Blood Bank, Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel
Mohty, Mohamad ; EBMT Study Office, Saint Antoine Hospital, Paris, France ; INSERM UMR 938, Sorbonne University, Paris, France ; Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Sorbonne University, Paris, France
The study has been performed on behalf of the Acute Leukemia Working Party of EBMT. The authors would like to acknowledge the invaluable contribution of the ALWP data managers to this work. According to EBMT rules, co-authorship has been offered to the centers contributing most patients to the analysis. Nevertheless, the authors wish to further acknowledge the contribution of all centers who reported their data on DLI to the ALWP registry (cf. Supplementary Table 5), hereby making this analysis possible.
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