Comparison of outcomes after donor lymphocyte infusion with or without prior chemotherapy for minimal residual disease in acute leukemia/myelodysplastic syndrome after allogeneic hematopoietic stem cell transplantation.
The efficacy of donor lymphocyte infusion (DLI) without chemotherapy was investigated and compared with that of chemotherapy prior to DLI (Chemo-DLI) in patients who were minimal residual disease (MRD)-positive after allogeneic hematopoietic stem cell transplantation (HSCT). We enrolled 115 consecutive patients who received either DLI (n = 20) or Chemo-DLI (n = 95) during the same period. For each DLI recipient, three recipients matched for age at the HSCT, underlying diseases, and the year of the HSCT were randomly selected from the Chemo-DLI cohort (n = 60). The 2-year cumulative incidence of severe acute graft-versus-host disease (GVHD) and chronic GVHD was comparable between the groups. Fifteen (75.0%) and 47 (78.3%) patients in the DLI and Chemo-DLI groups turned MRD-negative, respectively. The 2-year cumulative incidences of relapse and non-relapse mortality after intervention were 30.7 versus 39.6% (P = 0.582) and 10.3 versus 6.0% (P = 0.508) in the DLI and Chemo-DLI groups, respectively. The 2-year probabilities of disease-free, overall, and GVHD-free/relapse-free survival after preemptive intervention were 58.9 versus 54.3% (P = 0.862), 69.3 versus 78.1% (P = 0.361), and 44.4 versus 35.1% (P = 0.489) in the DLI and Chemo-DLI groups, respectively. In multivariate analysis, the intervention method did not significantly influence the clinical outcomes. In summary, preemptive DLI alone may be effective for patients who are MRD-positive and may be a potential alternative for patients who refuse or are unable to receive Chemo-DLI after HSCT.
['Mo|Xiao-Dong|XD|', 'Zhang|Xiao-Hui|XH|', 'Xu|Lan-Ping|LP|', 'Wang|Yu|Y|', 'Yan|Chen-Hua|CH|', 'Chen|Huan|H|', 'Chen|Yu-Hong|YH|', 'Han|Wei|W|', 'Wang|Feng-Rong|FR|', 'Wang|Jing-Zhi|JZ|', 'Liu|Kai-Yan|KY|', 'Huang|Xiao-Jun|XJ|']
D000293:Adolescent D000328:Adult D000971:Antineoplastic Combined Chemotherapy Protocols D002648:Child D002675:Child, Preschool D003131:Combined Modality Therapy D005260:Female D006086:Graft vs Host Disease D018380:Hematopoietic Stem Cell Transplantation D006648:Histocompatibility D006801:Humans D007938:Leukemia D017710:Lymphocyte Transfusion D008297:Male D008875:Middle Aged D009190:Myelodysplastic Syndromes D018365:Neoplasm, Residual D012008:Recurrence D012189:Retrospective Studies D016019:Survival Analysis D019172:Transplantation Conditioning D014184:Transplantation, Homologous D016896:Treatment Outcome D055815:Young Adult
Donor lymphocyte infusion Chemotherapy Minimal residual disease Hematopoietic stem cell transplantation Preemptive