| BackgroundAllogeneic hematopoietic stem cell transplantation is the most effective clinical method for the treatment of malignant hematological tumors.However,35%of the patients relapse after transplantation,which seriously affects the curative effect of stem cell transplantation.How to prevent and cure the recurrence after transplantation,reduce the recurrence,and improve the survival of patients after transplantation is a difficult problem after transplantation.Since the beginning of 1990s,Kolb etal,have reported that DLI has successfully achieved lasting complete remission in chronic myeloid leukemia who have relapsed after allo-HSCT.DLI has become a common method to prevent and treat the relapse of hematological malignant tumor after transplantation.The modified DLI can reduce the complications of DLI,improve the safety of DLI,and make DLI become an important means to improve the effect of transplantation and reduce the relapse.Donor lymphocyte infusion is a common means of adoptive immunotherapy at present,which mainly uses the donor's lymphocyte to mediate graft-versus-leukemia effect,so as to further eliminate the residual leukemic cells in the host.It is a further extension of graft-versus-leukemia after allo-HSCT,which can effectively treat and prevent relapse after transplantation.We started DLI in 2000,and since 2013 we've been conducting modified DLI under the guidance of minimal residual disease testing.Under the guidance of MRD,prophylactic DLI,was used to treat some of the patients who had relapsed after transplantation.This study retrospectively analyzed the difference between prophylactic DLI and therapeutic DLI and the safety of DLI for relapse after transplantation.ObjectiveThe purpose of this study was to retrospectively analyze the efficacy and safety of prophylactic DLI and therapeutic DLI in the treatment of relapse of acute leukemia after transplantation.MethodFrom 2013 to July 2017,73 allogeneic hematopoietic stem cell transplantation cases were performed,22 of which received donor lymphocyte infusion after transplantation:We retrospectively analyzed 22 cases of prophylactic or therapeutic donor lymphocyte infusion after allogeneic hematopoietic stem cell transplantation in Zhujiang Hospital and Shunde Hospital of Southern Medical University from August 2014 to May 2018.Among them,8 cases(36.4%)received prophylactic influsion and 14 cases(63.6%)received therapeutic infusion.All patients received drug chemotherapy and/or targeted drugs before DLI.ResultFrom 2013 to July 2017,27 of 73 cases of acute leukemia allogeneic hematopoietic stem cell transplantation relapsed,with a relapse rate of 37%.22 of the 27 recurrent patients received DLI.From the time of donor lymphocyte infusion to the last follow-up,9(41%)of the 22 patients,survived,and 8(36.7%)survived without recurrence.The 3-year OS and LFS of the total patients were 44.3%and 39.7%,respectively.The 3-year OS and LFS of the preventive DLI group were 63%and 63%respectively,while the 3-year OS and LFS of the therapeutic DLI group were 33%and 25.7%respectively.There was no significant difference in the OS and LFS.Of the 14 patients treated with DLI,11(78.6%)responded to DLI,9 of them achieved complete remission again,and the CR rate was 64.6%.The response rate of 8 cases with prophylactic infusion was 100%.The response rate of DLI between the two groups(78.6%vs 100%)was not statistically significant.The incidence of acute graft-versus-host disease(GVHD)was 55%after DLI infiusion,of which 9%were III-IV degree.The incidence of aGVHD in the prevention group and the treatment group was 50%and 57%,respectively.There was no significant difference in the incidence of aGVHD between the two groups(P=0.546).The incidence of chronic graft-versus-host disease in 22 patients was 55%.37.5%and 66%in the preventive DLI group and the treatment DLI group,respectively.And the incidence of severe cGVHD was 25.0%and 33.3%,respectively.The incidence of cGVHD and severe cGVHD in both groups was not statistically significant(p=0.362 and p=1.000).ConclusionDonor lymphocytes infusion is safe and effective in the treatment of recurrence after allotransplantation of acute leukemia.Preventive infusion may be superior to therapeutic infusion. |
PDF Full Text Request