Bone marrow CD34+ molecular chimerism as an early predictor of relapse after allogeneic stem cell transplantation in patients with acute myeloid leukemia

Malagola, Michele; Polverelli, Nicola; Beghin, Alessandra; Bolda, Federica; Comini, Marta; Farina, Mirko; Morello, Enrico; Radici, Vera; Buttini, Eugenia Accorsi; Bernardi, Simona; Re, Federica; Lanza, Antonio; Bonometti, Davide; Brugnoni, Duilio; Lanfranchi, Arnalda; Russo, Domenico

doi:10.3389/fonc.2023.1133418

Cited by 5 publications

(1 citation statement)

References 33 publications

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“…These findings prompted clinicians to identify the relapse as early as possible to adopt a pre-emptive treatment strategy [32]. The combination of MRD monitoring with lineage-specific molecular chimerism analysis appears to be the most sensitive way of detecting disease recurrence following allo-HCT [33]. Thus, in a recent work, the OS rate at 5 years after pre-emptive DLI for MRD/mixed chimerism was between 51% and 68% among responders and 37% among non-responders [34].…”

Section: Discussionmentioning

confidence: 99%

Donor Lymphocyte Infusion in the Treatment of Post-Transplant Relapse of Acute Myeloid Leukemias and Myelodysplastic Syndromes Significantly Improves Overall Survival: A French–Italian Experience of 134 Patients

Accorsi Buttini,

Doran,

Malagola

et al. 2024

Cancers

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Background: Disease relapse after allogeneic stem cell transplantation (allo-SCT) is the main challenge for curing acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). We investigated the overall survival (OS) after allo-SCT relapse according to different therapeutic approaches. Methods: We analyzed 134 patients who relapsed after allo-SCT performed between 2015 and 2021 at Saint-Antoine University Hospital, Paris and Spedali Civili di Brescia, Brescia. Of these, 103 (77%) were treated, comprising 69/103 (67%) who received therapy in overt relapse and 34/103 (33%) who were treated in a pre-emptive manner when molecular/cytogenetics recurrence or mixed chimerism occurred. The treatment was donor lymphocyte infusion (DLI)-based for 40/103 (39%) patients. Results: The 1-, 2-, and 5-year OS of patients treated with DLI (n = 40) was 67%, 34%, and 34%, respectively, for those treated preventively (n = 20) and 43%, 20%, and 20%, respectively, for those treated in overt relapse (n = 20) (p < 0.01). The 1-, 2-, and 5-year OS of patients treated without DLI (n = 63) was 54%, 40%, and 26%, respectively, for those treated preventively (n = 14) and 17%, 5%, and 0%, respectively, for those treated in overt relapse (n = 49) (p < 0.01). Conclusions: Relapse treatment with a pre-emptive strategy was associated with improved outcomes, particularly when DLI was employed.

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Section: Discussionmentioning

confidence: 99%

Donor Lymphocyte Infusion in the Treatment of Post-Transplant Relapse of Acute Myeloid Leukemias and Myelodysplastic Syndromes Significantly Improves Overall Survival: A French–Italian Experience of 134 Patients

Accorsi Buttini,

Doran,

Malagola

et al. 2024

Cancers

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CD34 Chimerism Directed Donor Lymphocyte Infusion With or Without Azacitidine Results in Reduced Relapse and Superior Overall Survival When Full Donor Chimerism is Achieved in Allogeneic Stem Cell Transplant Recipients With Acute Myeloid Leukaemia/Myelodysplastic Syndrome

Tan,

Curtis,

Muirhead

et al. 2024

Clinical Lymphoma Myeloma and Leukemia

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How I reduce and treat posttransplant relapse of MDS

Mina,

Greenberg,

Deeg

2024

Blood

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Allogeneic hematopoietic stem cell transplant (HSCT) is the only potentially curative option for patients with high-risk myelodysplastic syndromes (MDS). Advances in conditioning regimens and supportive measures have reduced treatment-related mortality and increased the role of transplantation, leading to more patients undergoing HSCT. However, post-transplant relapse of MDS remains a leading cause of morbidity and mortality for this procedure necessitating expert management and ongoing results analysis. In this article, we review treatment options and our institutional approaches to managing MDS relapse after HSCT using illustrative clinical cases that exemplify different clinical manifestations and management of relapse. We address areas of controversy relating to conditioning regimen intensity, chemotherapeutic bridging, and donor selection. In addition, we discuss future directions for advancing the field, including (1) the need for prospective clinical trials separating MDS from AML and focusing on post-transplant relapse, as well as (2) the validation of measurable residual disease methodologies to guide timely interventions.

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Bone marrow CD34+ molecular chimerism as an early predictor of relapse after allogeneic stem cell transplantation in patients with acute myeloid leukemia

Cited by 5 publications

References 33 publications

Donor Lymphocyte Infusion in the Treatment of Post-Transplant Relapse of Acute Myeloid Leukemias and Myelodysplastic Syndromes Significantly Improves Overall Survival: A French–Italian Experience of 134 Patients

Donor Lymphocyte Infusion in the Treatment of Post-Transplant Relapse of Acute Myeloid Leukemias and Myelodysplastic Syndromes Significantly Improves Overall Survival: A French–Italian Experience of 134 Patients

CD34 Chimerism Directed Donor Lymphocyte Infusion With or Without Azacitidine Results in Reduced Relapse and Superior Overall Survival When Full Donor Chimerism is Achieved in Allogeneic Stem Cell Transplant Recipients With Acute Myeloid Leukaemia/Myelodysplastic Syndrome

How I reduce and treat posttransplant relapse of MDS

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