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

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...

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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
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azacitidine
donor lymphocyte infusion
hematopoietic stem cell transplantation
myelodysplastic syndrome
relapse
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creator 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
description 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
doi_str_mv 10.1016/j.jcyt.2024.09.006
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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 &lt; 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 &lt;110 days post-transplant showed that the 1-year OS in patients with cytogenetic/molecular relapse was 43.6%, compared to 9.4% for those with hematologic relapse. Acute graft-versus-host disease (GVHD) occurred in 62.3% of patients, and chronic GVHD in 30.8%, with manageable outcomes. DLI may improve OS in younger patients, those with cytogenetic/molecular relapse, and those with late relapse. Despite the risk of GVHD, its impact on prognosis is minimal. 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subjects azacitidine
donor lymphocyte infusion
hematopoietic stem cell transplantation
myelodysplastic syndrome
relapse
title Outcome of donor lymphocyte infusion after allogeneic hematopoietic stem cell transplantation in relapsed myelodysplastic syndrome
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