Donor lymphocyte infusion after haploidentical hematopoietic stem cell transplantation for acute myeloid leukemia.
Kaito HaradaShohei MizunoShingo YanoAkiyoshi TakamiHiroto IshiiKazuhiro IkegameYuho NajimaShinichi KakoTakashi AshidaSouichi ShiratoriShuichi OtaMakoto OnizukaKentaro FukushimaTakahiro FukudaTatsuo IchinoheYoshiko AtsutaMasamitsu YanadaPublished in: Annals of hematology (2022)
Although haploidentical donor lymphocyte infusion (DLI) is a valid treatment option for relapsed acute myeloid leukemia (AML), the incidence and risk factors for graft-versus-host disease (GVHD) and the efficacy of haploidentical DLI have not been fully evaluated. We retrospectively analyzed the outcomes after haploidentical DLI for 84 patients with AML using a nationwide database and additional questionnaires. The median number of DLI cycles and infused CD3 + cell dose was 1 and 1.0 × 10 6 /kg, respectively. The infused CD3 + cell count of 5.0 × 10 5 /kg or higher was associated with acute GVHD (grade II-IV, 32.1% vs. 10.5%, p = 0.03; grade III-IV, 21.4% vs. 5.3%, p = 0.10). Patients who developed grade III-IV acute GVHD more frequently succumbed to treatment-related mortality (46.7% vs. 15.8% at 1 year, p = 0.002), although the relapse-related mortality was significantly low (40.0% vs. 72.2% at 1 year, p = 0.025). The overall response to DLI was significantly higher in the preemptive DLI group (47.4%) than in the therapeutic group (13.9%, p = 0.002). In the multivariate analysis, preemptive DLI was the predictive factor for overall response (odds ratio, 5.58; p = 0.003). Our results indicated the substantial risk of acute GVHD after haploidentical DLI with CD3 + cell count of 5.0×10 5 /kg or higher and the favorable outcomes after preemptive DLI.
Keyphrases
- acute myeloid leukemia
- allogeneic hematopoietic stem cell transplantation
- peripheral blood
- stem cell transplantation
- bone marrow
- liver failure
- single cell
- respiratory failure
- drug induced
- acute lymphoblastic leukemia
- cell therapy
- risk factors
- low dose
- cardiovascular events
- aortic dissection
- type diabetes
- cross sectional
- mesenchymal stem cells
- cardiovascular disease
- intensive care unit
- nk cells
- diffuse large b cell lymphoma
- adverse drug