Donor lymphocyte infusion after haploidentical hematopoietic stem cell transplantation for acute myeloid leukemia

Although haploidentical donor lymphocyte infusion (DLI) is a valid treatment option for relapsed acute myeloid leukemia (AML), the incidence and risk factors for graft-versus-host disease (GVHD) and the efficacy of haploidentical DLI have not been fully evaluated. We retrospectively analyzed the out...

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Published in:	Annals of hematology 2022-03, Vol.101 (3), p.643-653
Main Authors:	Harada, Kaito, Mizuno, Shohei, Yano, Shingo, Takami, Akiyoshi, Ishii, Hiroto, Ikegame, Kazuhiro, Najima, Yuho, Kako, Shinichi, Ashida, Takashi, Shiratori, Souichi, Ota, Shuichi, Onizuka, Makoto, Fukushima, Kentaro, Fukuda, Takahiro, Ichinohe, Tatsuo, Atsuta, Yoshiko, Yanada, Masamitsu
Format:	Article
Language:	eng
Subjects:	Adolescent Adult Blood Donors Female Graft versus host disease Graft vs Host Disease - diagnosis Graft vs Host Disease - etiology Hematology Hematopoietic Stem Cell Transplantation - adverse effects Humans Leukemia Leukemia, Myeloid, Acute - therapy Lymphocyte Transfusion Male Medicine Medicine & Public Health Middle Aged Mortality Oncology Original Article Retrospective Studies Young Adult
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Summary:	Although haploidentical donor lymphocyte infusion (DLI) is a valid treatment option for relapsed acute myeloid leukemia (AML), the incidence and risk factors for graft-versus-host disease (GVHD) and the efficacy of haploidentical DLI have not been fully evaluated. We retrospectively analyzed the outcomes after haploidentical DLI for 84 patients with AML using a nationwide database and additional questionnaires. The median number of DLI cycles and infused CD3 + cell dose was 1 and 1.0 × 10 6 /kg, respectively. The infused CD3 + cell count of 5.0 × 10 5 /kg or higher was associated with acute GVHD (grade II–IV, 32.1% vs. 10.5%, p = 0.03; grade III–IV, 21.4% vs. 5.3%, p = 0.10). Patients who developed grade III–IV acute GVHD more frequently succumbed to treatment-related mortality (46.7% vs. 15.8% at 1 year, p = 0.002), although the relapse-related mortality was significantly low (40.0% vs. 72.2% at 1 year, p = 0.025). The overall response to DLI was significantly higher in the preemptive DLI group (47.4%) than in the therapeutic group (13.9%, p = 0.002). In the multivariate analysis, preemptive DLI was the predictive factor for overall response (odds ratio, 5.58; p = 0.003). Our results indicated the substantial risk of acute GVHD after haploidentical DLI with CD3 + cell count of 5.0×10 5 /kg or higher and the favorable outcomes after preemptive DLI.
ISSN:	0939-5555 1432-0584