Modified Donor Lymphocyte Infusion (DLI) for the Prophylaxis of Leukemia Relapse after Hematopoietic Stem Cell Transplantation in Patients with Advanced Leukemia—Feasibility and Safety Study

Huang, Xiao‐Jun; Wang, Yu; Liu, Dai‐Hong; Xu, Lei; Chen, Huan; Chen, Yuhong; Han, Wei; Shi, Hongxia; Liu, Kai-Yan

doi:10.1007/s10875-008-9193-4

Cited by 65 publications

(54 citation statements)

References 20 publications

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“…In these advanced stages, especially in patients with positive MRD, prophylactic donor lymphocyte infusion may reduce subsequent relapse in the posttransplant phase; a point that requires further investigation. 13,14 Despite a cohort of very advanced disease, overall survival (45%) and disease free survival (50%, data not shown) are comparable to previous reports on patients transplanted in CR2. 6,8 Thus, allogeneic transplant is capable of producing long-term remissions in such advanced disease.…”

Section: Resultssupporting

confidence: 84%

Allogeneic stem cell transplantation for advanced acute promyelocytic leukemia in the ATRA and ATO era

Ramadan

Camboni

Breccia³

et al. 2012

Haematologica

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The role of allogeneic stem cell transplant in advanced acute promyelocytic leukemia patients who received standard first and second-line therapy is still unknown. We report the outcome of 31 acute promyelocytic leukemia patients (median age 39) who underwent allogeneic transplant in second-remission (15patients) or beyond (16patients. Sixteen patients were RT-PCR positive and 15 negative for PML/RARA pre-transplant. The 4-year overall-survival was 62 % and 31% for patients transplanted in second-remission and beyond, respectively (p=0.05) and 64% and 27% for patients with RT-PCR-negative and positive pre-transplant, respectively (p=0.03). The 4-year cumulative-incidence of relapse was 32% and 44% for patients transplanted in second-remission and beyond, respectively (p=0.37) and 30% and 47% for patients transplanted with negative and positive RT-PCR, respectively (p=0.30). Transplant-related mortality was 19.6%. In conclusion, allogeneic transplant is effective in advanced acute promyelocytic leukemia in the all-trans-retinoic acid and arsenic trioxide era and should be considered once relapse is diagnosed

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Section: Resultssupporting

confidence: 84%

Allogeneic stem cell transplantation for advanced acute promyelocytic leukemia in the ATRA and ATO era

Ramadan

Camboni

Breccia³

et al. 2012

Haematologica

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“…The protocol and condition of transplantation were as previously reported. [16][17][18][19][20][21][22][23] HLA typing procedures: A HLA-matched sibling donor was the first choice for allo-HSCT. If a matched sibling donor was unavailable as a first treatment option, patients without a suitable closely HLA-matched unrelated donor, that is, with more than eight of 10 matching HLA-A, B, C, DR and DQ loci and at least five of six matching HLA-A, B and DR loci, or whose disease status left insufficient time for an unrelated donor search, were eligible for haploidentical HSCT.…”

Section: Therapeutic Clinical Management Schemementioning

confidence: 99%

Allogeneic hematopoietic SCT in combination with tyrosine kinase inhibitor treatment compared with TKI treatment alone in CML blast crisis

Jiang

et al. 2014

Bone Marrow Transplant

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CML treatment with tyrosine kinase inhibitors (TKIs) has improved many patients' prognosis, but during the disease's terminal phase, the blast crisis (CML-BC), has been disappointing. Allo-HSCT is another treatment, but survival rates are still disappointing. Currently, a combination of these two is suggested but with little evidence. This retrospective comparison reports on this combination and TKI alone for treatment of CML-BC. Of the 83 CML-BC patients, 45 received TKIs (imatinib; nilotinb or dasatinib after imatinib resistance; TKIs group) and 38 were treated with allo-HSCT after TKI (TKIs+allo-HSCT group). Treatment success was measured in terms of the hematologic, cytogenic and molecular responses, and subject outcome. Follow-up was 30-126 months or until death. Univariate and multivariate analyses determined EFS and OS predictors. Allo-HSCT significantly improved the 4-year OS (46.7 vs 9.7%, P o 0.001) and EFS (47.1 vs 6.7%, P o 0.001) compared to TKI treatment alone. Hemoglobin o 100 g/L, non-return to chronic phase after TKI therapy and TKI treatment alone are independent adverse predictors of OS and EFS. Allo-HSCT with individualized intervention after TKI therapy is superior to TKI alone for CML-BC.

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“…The modified DLI (mDLI) regimen comprised G-CSF-primed PBSCs instead of harvested non-primed donor lymphocytes and short-term immunosuppressive agents. 12,13 Infection and supportive care All patients were hospitalized in rooms with high-efficiency particle-arresting (HEPA) air filters and received antibiotic prophylaxis with oral trimethoprim-sulfamethoxazole, fluconazole and acyclovir starting at day 10 before transplantation. All blood products were irradiated before infusion.…”

Section: DLImentioning

confidence: 99%

The inferiority of G-PB to rhG-CSF-mobilized blood and marrow grafts as a stem cell source in patients with high-risk acute leukemia who underwent unmanipulated HLA-mismatched/haploidentical transplantation: a comparative analysis

et al. 2009

Bone Marrow Transplant

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The purpose of this study was to investigate the efficacy and feasibility of unmanipulated haploidentical PBSCT for the treatment of acute leukemia (AL). This study compares the clinical outcomes of high-risk AL patients who received PBSCs harvested from family members sharing at least one common haplotype to outcomes of high-risk AL patients who received a mixture of G-CSFprimed BM (G-BM) and peripheral blood (G-PB) harvests. The results show that PBSCT achieved inferior cumulative myeloid engraftment at 30 days after transplant (89.9 ± 10.1% vs 100%; P ¼ 0.04), with lower cumulative incidence of grade II-IV acute GVHD (aGVHD) (37.1 ± 16.5% vs 63.2 ± 6%; P ¼ 0.058) compared with G-BM/G-PB transplant. However, both transplant protocols had similar rates of 2-year relapse (29.6±17.1% vs 34.0±5.7%; P ¼ 0.954), and PBSCT produced a higher incidence of 2-year non-leukemic mortality (62.5 ± 14.8% vs 35.1 ± 5.1%; P ¼ 0.014), as well as lower rates of overall (26.8±12.3% vs 43.2 ± 5.0%; P ¼ 0.052) and disease-free survival (26.8 ± 12.3% vs 42.4 ± 5.0%; P ¼ 0.071) compared with G-BM/G-PB transplant. These results suggest that haploidentical HSCT is an option for patients with AL who urgently need a graft and do not have matched sibling donors. PBSCT is potentially inferior to G-BM/G-PB transplant, and improvements should be made before PBSCT becomes a routine in unmanipulated mismatched/ haploidentical transplant settings.

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Modified Donor Lymphocyte Infusion (DLI) for the Prophylaxis of Leukemia Relapse after Hematopoietic Stem Cell Transplantation in Patients with Advanced Leukemia—Feasibility and Safety Study

Abstract: The modified prophylactic DLI strategy might represent a step forward in the treatment of advanced leukemia.

Cited by 65 publications

References 20 publications

Allogeneic stem cell transplantation for advanced acute promyelocytic leukemia in the ATRA and ATO era

Allogeneic stem cell transplantation for advanced acute promyelocytic leukemia in the ATRA and ATO era

Allogeneic hematopoietic SCT in combination with tyrosine kinase inhibitor treatment compared with TKI treatment alone in CML blast crisis

The inferiority of G-PB to rhG-CSF-mobilized blood and marrow grafts as a stem cell source in patients with high-risk acute leukemia who underwent unmanipulated HLA-mismatched/haploidentical transplantation: a comparative analysis

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