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    Long-term results and GvHD after prophylactic and preemptive donor lymphocyte infusion after allogeneic stem cell transplantation for acute leukemia

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    Authors
    Schmid, C.
    Labopin, M.
    Schaap, N.
    Veelken, H.
    Brecht, A.
    Stadler, M.
    Finke, J.
    Baron, F.
    Collin, M.
    Bug, G.
    Ljungman, P.
    Blaise, D.
    Tischer, J.
    Bloor, Adrian
    Kulagin, A.
    Giebel, S.
    Gorin, N. C.
    Esteve, J.
    Ciceri, F.
    Savani, B.
    Nagler, A.
    Mohty, M.
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    Affiliation
    Department of Hematology and Oncology, Augsburg University Hospital and Medical Faculty, Augsburg, Germany
    Issue Date
    2021
    
    Metadata
    Show full item record
    Abstract
    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.
    Citation
    Schmid C, Labopin M, Schaap N, Veelken H, Brecht A, Stadler M, et al. Long-term results and GvHD after prophylactic and preemptive donor lymphocyte infusion after allogeneic stem cell transplantation for acute leukemia [Internet]. Bone Marrow Transplantation. Springer Science and Business Media LLC; 2021.
    Journal
    Bone Marrow Transplantation
    URI
    http://hdl.handle.net/10541/624777
    DOI
    10.1038/s41409-021-01515-3
    PubMed ID
    34750562
    Additional Links
    https://dx.doi.org/10.1038/s41409-021-01515-3
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1038/s41409-021-01515-3
    Scopus Count
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