Analysis of relapse after transplantation in acute leukemia: A comparative on second allogeneic hematopoietic cell transplantation and donor lymphocyte infusions

Guillermo Ortí, Jaime Sanz, Irene García-Cadenas, Isabel Sánchez-Ortega, Laura Alonso, Maria José Jiménez, Luisa Sisinni, Carmen Azqueta, Olga Salamero, Isabel Badell, Christelle Ferra, Cristina Diaz de Heredia, Rocio Parody, Miguel Angel Sanz, Jorge Sierra, Jose Luis Piñana, Sergi Querol, David Valcárcel

Research output: Contribution to journalArticleResearchpeer-review

8 Citations (Scopus)

Abstract

© 2018 ISEH – Society for Hematology and Stem Cells Relapse of acute leukemia (AL) after allogeneic hematopoietic cell transplantation (Allo-HCT) entails a dismal prognosis. In this scenario, donor lymphocyte infusions (DLIs) and second Allo-HCT are two major approaches. We compared outcomes of AL patients treated for relapse with DLI or second Allo-HCT after receiving debulking therapy. In total, 46 patients were included in the study; 30 (65%) had acute myeloid leukemia and 16 (35%) had acute lymphoblastic leukemia. The median age was 38 years (range 4–66). Twenty-seven patients received a second Allo-HCT and 19 patients received DLI. The median follow-up of the cohort was 273 days (range 9–7013). Overall survival (OS), disease-free survival (DFS), nonrelapse mortality, and cumulative incidence (CI) of relapse were calculated from DLI or second Allo-HCT date. In univariate analysis, second Allo-HCT was associated with higher OS (p = 0.021) and a trend to higher DFS (p = 0.097) and CI of relapse (p = 0.094) on univariate analysis. However, multivariate analysis showed comparable outcomes between DLI and second Allo-HCT, with the time interval to relapse before DLI or second Allo-HCT the only statistically significant factor with an impact on OS and DFS. Within the DLI cohort, T-cell-depleted Allo-HCT was associated with higher OS (p = 0.003) and DFS (p < 0.001) and lower CI of relapse (p = 0.002) than T-cell-replete Allo-HCT. Overall, in this cohort of AL patients, second Allo-HCT and DLI associated similar outcomes. As in other relapse studies, the length of remission (time to relapse) was identified as a factor with statistical impact on survival. Further studies are warranted.
Original languageEnglish
Pages (from-to)24-32
JournalExperimental Hematology
Volume62
DOIs
Publication statusPublished - 1 Jun 2018

Fingerprint Dive into the research topics of 'Analysis of relapse after transplantation in acute leukemia: A comparative on second allogeneic hematopoietic cell transplantation and donor lymphocyte infusions'. Together they form a unique fingerprint.

Cite this