Analysis of relapse after transplantation in acute leukemia: A comparative on second allogeneic hematopoietic cell transplantation and donor lymphocyte infusions

被引:15
作者
Orti, Guillermo [1 ]
Sanz, Jaime [2 ]
Garcia-Cadenas, Irene [3 ,4 ]
Sanchez-Ortega, Isabel [5 ]
Alonso, Laura [6 ]
Jose Jimenez, Maria [7 ]
Sisinni, Luisa [8 ]
Azqueta, Carmen [9 ]
Salamero, Olga [1 ]
Badell, Isabel [8 ]
Ferra, Christelle [7 ]
Diaz de Heredia, Cristina [6 ]
Parody, Rocio [5 ]
Angel Sanz, Miguel [2 ]
Sierra, Jorge [3 ,4 ]
Luis Pinana, Jose [2 ]
Querol, Sergi [9 ]
Valcarcel, David [1 ]
机构
[1] Univ Autonoma Barcelona, Hosp Univ Vall dHebron VHIO, Dept Hematol, Barcelona, Spain
[2] Univ Valencia, Hosp Univ la Fe, Valencia, Spain
[3] Univ Autonoma Barcelona, Jose Carreras Leukemia Res Inst, Hosp Santa Creu & St Pau, Dept Hematol, Barcelona, Spain
[4] Univ Autonoma Barcelona, IIB St Pau, Barcelona, Spain
[5] Hosp Duran & Reynals ICO Barcelona, Dept Hematol, Barcelona, Spain
[6] Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Paediat Oncol & Hematol Dept, Barcelona, Spain
[7] Hosp Badalona Germans Trias & Pujol, Jose Carreras Res Inst, Inst Catala Oncol, Hematol Dept, Barcelona, Spain
[8] Univ Autonoma Barcelona, Paediat Oncol & Haematol Dept, Hosp Santa Creu & St Pau, Barcelona, Spain
[9] Banc Sang & Teixits Barcelona, Barcelona, Spain
关键词
BONE-MARROW-TRANSPLANTATION; ACUTE MYELOID-LEUKEMIA; VERSUS-HOST-DISEASE; BLOOD STEM-CELLS; LEUKOCYTE INFUSIONS; WORKING PARTY; PROSPECTIVE TRIAL; SIBLING DONOR; RISK-FACTORS; MALIGNANCIES;
D O I
10.1016/j.exphem.2018.03.002
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Relapse of acute leukemia (AL) after allogeneic hematopoietic cell transplantation (Allo-HCT) entails a dismal prognosis. In this scenario, donor lymphocyte infusions (DLIs) and second Allo-HCT are two major approaches. We compared outcomes of AL patients treated for relapse with DLI or second Allo-HCT after receiving debulking therapy. In total, 46 patients were included in the study; 30 (65%) had acute myeloid leukemia and 16 (35%) had acute lymphoblastic leukemia. The median age was 38 years (range 4-66). Twenty-seven patients received a second Allo-HCT and 19 patients received DLI. The median follow-up of the cohort was 273 days (range 9-7013). Overall survival (OS), disease-free survival (DFS), nonrelapse mortality, and cumulative incidence (CI) of relapse were calculated from DLI or second Allo-HCT date. In univariate analysis, second Allo-HCT was associated with higher OS (p = 0.021) and a trend to higher DFS (p = 0.097) and CI of relapse (p = 0.094) on univariate analysis. However, multivariate analysis showed comparable outcomes between DLI and second Allo-HCT, with the time interval to relapse before DLI or second Allo-HCT the only statistically significant factor with an impact on OS and DFS. Within the DLI cohort, T-cell-depleted Allo-HCT was associated with higher OS (p = 0.003) and DFS (p < 0.001) and lower CI of relapse (p = 0.002) than T-cell-replete Allo-HCT. Overall, in this cohort of AL patients, second Allo-HCT and DLI associated similar outcomes. As in other relapse studies, the length of remission (time to relapse) was identified as a factor with statistical impact on survival. Further studies are warranted. (C) 2018 ISEH Society for Hematology and Stem Cells. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:24 / 32
页数:9
相关论文
共 25 条
[1]   A disease risk index for patients undergoing allogeneic stem cell transplantation [J].
Armand, Philippe ;
Gibson, Christopher J. ;
Cutler, Corey ;
Ho, Vincent T. ;
Koreth, John ;
Alyea, Edwin P. ;
Ritz, Jerome ;
Sorror, Mohamed L. ;
Lee, Stephanie J. ;
Deeg, H. Joachim ;
Storer, Barry E. ;
Appelbaum, Frederick R. ;
Antin, Joseph H. ;
Soiffer, Robert J. ;
Kim, Haesook T. .
BLOOD, 2012, 120 (04) :905-913
[2]  
ATKINSON K, 1990, BONE MARROW TRANSPL, V5, P69
[3]   Prolonged survival in adults with acute lymphoblastic leukemia after reduced-intensity conditioning with cord blood or sibling donor transplantation [J].
Bachanova, Veronika ;
Verneris, Michael R. ;
DeFor, Todd ;
Brunstein, Claudio G. ;
Weisdorf, Daniel J. .
BLOOD, 2009, 113 (13) :2902-2905
[4]  
BAR BMAM, 1993, J CLIN ONCOL, V11, P513
[5]   Donor Lymphocyte Infusion for Relapsed Hematological Malignancies after Allogeneic Hematopoietic Cell Transplantation: Prognostic Relevance of the Initial CD3+ T Cell Dose [J].
Bar, Merav ;
Sandmaier, Brenda M. ;
Inamoto, Yoshihiro ;
Bruno, Benedetto ;
Hari, Parameswaran ;
Chauncey, Thomas ;
Martin, Paul J. ;
Storb, Rainer ;
Maloney, David G. ;
Storer, Barry ;
Flowers, Mary E. D. .
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION, 2013, 19 (06) :949-957
[6]   Impact of in vivo T-cell depletion on outcome of AML patients in first CR given peripheral blood stem cells and reduced-intensity conditioning allo-SCT from a HLA-identical sibling donor: a report from the Acute Leukemia Working Party of the European group for Blood and Marrow Transplantation [J].
Baron, F. ;
Labopin, M. ;
Blaise, D. ;
Lopez-Corral, L. ;
Vigouroux, S. ;
Craddock, C. ;
Attal, M. ;
Jindra, P. ;
Goker, H. ;
Socie, G. ;
Chevallier, P. ;
Browne, P. ;
Sandstedt, A. ;
Duarte, R. F. ;
Nagler, A. ;
Mohty, M. .
BONE MARROW TRANSPLANTATION, 2014, 49 (03) :389-396
[7]   Survival of Patients with Acute Myeloid Leukemia Relapsing after Allogeneic Hematopoietic Cell Transplantation: A Center for International Blood and Marrow Transplant Research Study [J].
Bejanyan, Nelli ;
Weisdorf, Daniel J. ;
Logan, Brent R. ;
Wang, Hai-Lin ;
Devine, Steven M. ;
de Lima, Marcos ;
Bunjes, Donald W. ;
Zhang, Mei-Jie .
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION, 2015, 21 (03) :454-459
[8]   Outcome of patients developing GVHD after DLI given to treat CML relapse: a study by the chronic leukemia working party of the EBMT [J].
Chalandon, Y. ;
Passweg, J. R. ;
Schmid, C. ;
Olavarria, E. ;
Dazzi, F. ;
Simula, M. P. ;
Ljungman, P. ;
Schattenberg, A. ;
de Witte, T. ;
Lenhoff, S. ;
Jacobs, P. ;
Volin, L. ;
Iacobelli, S. ;
Finke, J. ;
Niederwieser, D. ;
Guglielmi, C. .
BONE MARROW TRANSPLANTATION, 2010, 45 (03) :558-564
[9]   Donor leukocyte infusions in acute lymphocytic leukemia [J].
Collins, RH ;
Goldstein, S ;
Giralt, S ;
Levine, J ;
Porter, D ;
Drobyski, W ;
Barrett, J ;
Johnson, M ;
Kirk, A ;
Horowitz, M ;
Parker, P .
BONE MARROW TRANSPLANTATION, 2000, 26 (05) :511-516
[10]   Comparison of single-dose and escalating-dose regimens of donor lymphocyte infusion for relapse after allografting for chronic myeloid leukemia [J].
Dazzi, F ;
Szydlo, RM ;
Craddock, C ;
Cross, NCP ;
Kaeda, J ;
Chase, A ;
Olavarria, E ;
van Rhee, F ;
Kanfer, E ;
Apperley, JF ;
Goldman, JM .
BLOOD, 2000, 95 (01) :67-71