Outcome of donor lymphocyte infusion after allogeneic hematopoietic stem cell transplantation in relapsed myelodysplastic syndrome

• Published in: Cytotherapy (Oxford, England) England), 2024-10
• Main Authors: Marumo, Atsushi, Nagata, Yasunobu, Fujioka, Machiko, Kurosawa, Shuhei, Najima, Yuho, Sakaida, Emiko, Doki, Noriko, Fukushima, Kentaro, Ota, Shuichi, Shono, Katsuhiro, Ito, Ayumu, Uchida, Naoyuki, Nishida, Tetsuya, Sawa, Masashi, Tsunemine, Hiroko, Matsuoka, Ken-ichi, Makoto, Onizuka, Kanda, Yoshinobu, Fukuda, Takahiro, Atsuta, Yoshiko, Itonaga, Hidehiro
• Format: Article
• Language: English
• Subjects: azacitidine; donor lymphocyte infusion; hematopoietic stem cell transplantation; myelodysplastic syndrome; relapse
• ISSN: 1465-3249; 1477-2566; 1477-2566
• DOI: 10.1016/j.jcyt.2024.09.006

Allogeneic hematopoietic stem cell transplantation (HSCT) improves outcomes for myelodysplastic syndrome (MDS) patients, but relapse rates remain high, and postrelapse treatment options are limited. Therefore, this study aimed to identify the factors contributing to the response to donor lymphocyte infusion (DLI) in relapsed MDS patients post-HSCT. This study included 107 patients with relapsed and DLI-treated MDS who underwent their first HSCT between 2002 and 2022 and were registered in the Transplant Registry Unified Program. Univariate and multivariate survival analyses were conducted using log-rank tests and Cox proportional hazards models. Overall survival (OS) and response rates to DLI were also analyzed. The 1-year OS was 30.0% and univariate analysis identified poor prognostic factors: age ≥58 years (P = 0.003), complex karyotype (P = 0.026), hematologic relapse (P = 0.026) and early relapse (P = 0.004). Azacitidine plus DLI also improved prognosis (P < 0.001). Multivariate analysis confirmed age ≥58 years, hematologic relapse, and early relapse as poor prognostic factors. The adjusted OS for patients aged ≥58 years who relapsed