Donor Lymphocyte Infusions Used to Treat Mixed-Chimeric and High-Risk Patient Populations in the Relapsed and Nonrelapsed Settings after Allogeneic Transplantation for Hematologic Malignancies Are Associated with High Five-Year Survival if Persistent Full Donor Chimerism Is Obtained or Maintained

•Donor lymphocyte infusions were administered according to a dose-escalation protocol•Persistent full donor chimerism is essential for long-term disease control•Patients given donor lymphocyte infusions in nonrelapsed settings had high 5-year overall survival (69%) and progression-free survival (71%...

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Published in:Biology of blood and marrow transplantation 2017-11, Vol.23 (11), p.1989-1997
Main Authors: Caldemeyer, Lauren E., Akard, Luke P., Edwards, John R., Tandra, Anand, Wagenknecht, Dawn R., Dugan, Michael J.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Allogeneic hematopoietic stem cell transplantation
Chimerism
Disease-Free Survival
Donor lymphocyte infusions (DLI)
Female
Hematologic malignancy
Hematologic Neoplasms - mortality
Hematologic Neoplasms - pathology
Hematologic Neoplasms - therapy
Humans
Lymphocyte Transfusion - methods
Male
Middle Aged
Mixed chimerism
Recurrence
Survival Analysis
Time Factors
Tissue Donors
Transplantation Chimera
Transplantation, Homologous - methods
Young Adult
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Summary:•Donor lymphocyte infusions were administered according to a dose-escalation protocol•Persistent full donor chimerism is essential for long-term disease control•Patients given donor lymphocyte infusions in nonrelapsed settings had high 5-year overall survival (69%) and progression-free survival (71%)•Donor lymphocyte infusions given for overt relapse are of lesser benefit: 5-year overall survival of 28% and progression-free survival of 18% Mixed chimerism (MC), a persistent or increasing number of host cells after allogeneic hematopoietic stem cell transplantation (HSCT), is a predictor of disease relapse. Donor lymphocyte infusions (DLI) have the potential to enhance the graft-versus-malignancy (GVM) effect, reducing the risk of relapse in patients with MC. Hence, in addition to utilizing DLI in the relapsed setting, there is a motivation to pursue pre-emptive DLI for patients in complete remissions after HSCT. To assess the safety and efficacy of DLI, records of 86 patients who received DLI between 2003 and 2015 at a single institution were studied retrospectively. Patients who received DLI included 50 patients with relapsed/residual (RR) disease, 29 patients with emerging MC without detectable disease, and 7 patients in an “other” cohort who had neither RR disease nor emerging MC after HSCT. DLI were administered using a dose-escalation protocol. After DLI, 93% of MC patients converted to full donor chimerism (FDC). Nonrelapsed patients (MC and other) reported high overall survival (OS) at 1 and 5 years (83% at 1 year, 70% at 5 years for MC; 86% at 1 year, 69% at 5 years for other) and was statistically superior to 5-year OS for RR patients (nonrelapsed 69% versus RR 28%; P = .00032). Improved survival correlated with successful conversion to FDC after DLI for RR and MC cohorts: 71% 2-year OS for patients converted to FDC versus 13% for patients who failed to achieve FDC (P 
ISSN:1083-8791
1523-6536
DOI:10.1016/j.bbmt.2017.07.007