Donor Lymphocyte Infusions for Chronic Myeloid Leukemia Relapsing after Allogeneic Stem Cell Transplantation: May We Predict Graft-versus-Leukemia Without Graft-versus-Host Disease?

• Published in: Biology of blood and marrow transplantation 2015-07, Vol.21 (7), p.1230-1236
• Main Authors: Radujkovic, Aleksandar, Guglielmi, Cesare, Bergantini, Stefania, Iacobelli, Simona, van Biezen, Anja, Milojkovic, Dragana, Gratwohl, Alois, Schattenberg, Antonius V.M.B, Verdonck, Leo F, Niederwieser, Dietger W, de Witte, Theo, Kröger, Nicolaus, Olavarria, Eduardo
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Allogeneic stem cell transplantation; Child; Child, Preschool; Chromosome Aberrations; Chronic Disease; Chronic myeloid leukemia; Donor lymphocyte infusions; Female; Graft vs Host Disease - etiology; Graft vs Host Disease - immunology; Graft vs Host Disease - mortality; Graft vs Host Disease - prevention & control; Graft vs Leukemia Effect; Graft-versus-host disease; Graft-versus-leukemia; Hematology, Oncology and Palliative Medicine; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Immunosuppressive Agents - therapeutic use; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - immunology; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - mortality; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - pathology; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - therapy; Lymphocyte Transfusion; Male; Middle Aged; Myeloablative Agonists - therapeutic use; Prognosis; Recurrence; Relapse; Retrospective Studies; Sex Factors; Siblings; Survival Analysis; Transplantation Conditioning; Transplantation, Homologous; Unrelated Donors
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2015.03.012

Abstract Donor lymphocyte infusions (DLI) are an effective treatment for relapsed chronic myeloid leukemia (CML) after allogeneic stem cell transplantation (alloSCT). Leukemia resistance and secondary graft-versus-host disease (GVHD) are major obstacles to success with DLI. The aim of this study was to identify pre-DLI factors associated with prolonged survival in remission without secondary GVHD. We retrospectively analyzed 500 patients treated with DLI for CML relapse (16% molecular, 30% cytogenetic, and 54% hematological) after alloSCT. The overall probabilities of failure- and secondary GVHD–free survival (FGFS) were 29% and 27% at 5 and 10 years after DLI, respectively. The type of relapse was the major factor influencing FGFS (40% for molecular and/or cytogenetic relapse and 20% for hematological relapse at 5 years, P < .001). Chronic GVHD before DLI and an interval 50% at 5 years) when DLI were given beyond 1 year from alloSCT for molecular and/or cytogenetic CML relapse that was not preceded by chronic GVHD.