Su Qiongqiong, Fan Zhiping, Huang Fen, Xu Na, Nie Danian, Lin Dongjun, Guo Ziwen, Shi Pengcheng, Wang Zhixiang, Jiang Ling, Sun Jing, Jiang Zujun, Liu Qifa, Xuan Li
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Front Oncol. 2021 Mar 3;11:554503. doi: 10.3389/fonc.2021.554503. eCollection 2021.
Prophylactic donor lymphocyte infusion (pDLI) could reduce relapse in patients with refractory/relapsed acute leukemia (RRAL) undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT), but optimal timing of pDLI remains uncertain. We compared the outcomes of two strategies for pDLI based on time from transplant and minimal residual disease (MRD) status in patients with RRAL. For patients without grade II-IV acute graft-versus-host disease (aGVHD) on day +60, pDLI was given on day +60 regardless of MRD in cohort 1, and was given on day +90 unless MRD was positive on day +60 in cohort 2. A total of 161 patients with RRAL were enrolled, including 83 in cohort 1 and 78 in cohort 2. The extensive chronic GVHD (cGVHD) incidence in cohort 2 was lower than that in cohort 1 (10.3% vs. 27.9%, = 0.006) and GVHD-free/relapse-free survival (GRFS) in cohort 2 was superior to that in cohort 1 (55.1% vs. 41.0%, = 0.042). The 2-year relapse rate, overall and leukemia-free survival were comparable between the two cohorts (29.0% vs. 28.2%, = 0.986; 63.9% vs. 64.1%, = 0.863; 57.8% vs. 61.5%, = 0.666). Delaying pDLI to day +90 based on MRD for patients with RRAL undergoing allo-HSCT could lower extensive cGVHD incidence and improve GRFS without increasing incidence of leukemia relapse compared with pDLI on day +60.
预防性供体淋巴细胞输注（pDLI）可降低接受异基因造血干细胞移植（allo-HSCT）的难治性/复发性急性白血病（RRAL）患者的复发率，但pDLI的最佳时机仍不确定。我们比较了RRAL患者基于移植时间和微小残留病（MRD）状态的两种pDLI策略的结果。对于在+60天时无II-IV级急性移植物抗宿主病（aGVHD）的患者，队列1中无论MRD情况如何，均在+60天时给予pDLI，而队列2中除非在+60天时MRD为阳性，否则在+90天时给予pDLI。共有161例RRAL患者入组，其中队列1有83例，队列2有78例。队列2中广泛慢性移植物抗宿主病（cGVHD）的发生率低于队列1（10.3%对27.9%，P = 0.006），队列2的无移植物抗宿主病/无复发生存率（GRFS）优于队列1（55.1%对41.0%，P = 0.042）。两个队列的2年复发率、总生存率和无白血病生存率相当（29.0%对28.2%，P = 0.986；63.9%对64.1%，P = 0.863；57.8%对61.5%，P = 0.666）。与在+60天时给予pDLI相比，对于接受allo-HSCT的RRAL患者，基于MRD将pDLI推迟至+90天可降低广泛cGVHD的发生率并改善GRFS，而不会增加白血病复发率。
