Donor lymphocyte infusion for relapsed chronic myelogenous leukemia: prognostic relevance of the initial cell dose

Abstract

were given to 62%, 20%, and 5% of patients in groups A, B, and C, respectively. A lower ICD was associated with less graft-versus-host disease (GVHD; A, 26%; B, 53%; C, 62%; P < .001), less myelosuppression (A, 10%; B, 23%; C, 24%; P ‫؍‬ .01), and similar response rate (A, 78%; B, 73%; C, 70%; P ‫؍‬ .48). Nonadjusted estimates of 3-year survival, failurefree survival, and DLI-related mortality were 84%, 66%, and 5% respectively, in group A; 63%, 57%, and 20% in group B; and 58%, 45%, and 22% in group C. Outcome analysis was adjusted for patient age, donor type, sex of donor, sex mismatch, disease phase at transplantation, T-cell depletion, interval from transplantation to DLI, GVHD prior to relapse, relapse type, and date of DLI. After adjustment, lower ICD was associated with less GVHD, less myelosuppression, same response rate, better survival, better failure-free survival, and less DLI-related mortality. Our results suggest that the first DLI dose should not exceed 0.

Leucemia mieloide crônica e outras doenças mieloproliferativas crônicas

“…50 O transplante de intensidade reduzida (CIR) foi introduzido em 1998. Desde a sua introdução até 2004 houve um crescimento de 30% nesta modalidade de TCHP.…”

“…Por outro lado, há uma maior incidência de DECH-a grau 3 a 4 e uma maior incidência da DECH crônica extensa quando se realiza um TCHPP. 50 Nas doenças avançadas, ou seja, além da 1ª FC, há uma vantagem em relação à sobrevida global e sobrevida livre de doença, com diminuição da incidência da recidiva. 47,51 Outras indicações de TCHP Deve-se pensar em TCHP quando há presença da mutação na região da alça P, quando há mutação T315I, ou quando há resistência ao imatinibe se não há possibilidade de utilizar um inibidor da tirosina quinase de 2ª geração.…”

“…A remissão molecular duradoura é alcançada na maioria dos pacientes que recidivam na fase crônica. [76][77][78][79] A DECH e a aplasia da medula continuam sendo as duas complicações mais importantes da ILD, mas, quando se utiliza um esquema com doses escalonadas, estes problemas são amplamentes reduzidos. 79,80 Um estudo do grupo europeu de transplante de medula óssea e sangue periférico (EBMT) mostrou que a sobrevida após a recidiva citogenética ou hematológica estava associada a cinco fatores: tempo entre o diagnóstico e o transplante, fase da doença no transplante e na recidiva, tempo entre o transplante e a recidiva e tipo de doador.…”

Donor lymphocyte infusions for the treatment of chronic myeloid leukemia relapse following peripheral blood or bone marrow stem cell transplantation

“…In CML, this treatment is very efficacious and has been shown to induce remission in 60-87% of patients of which about 90% are believed to be cured. [6][7][8][9] However, only 58% of patients are estimated to be alive after 5 years following DLI, and the main causes of mortality are CML relapse and complications of this procedure. 6 A number of factors were shown to be related with improved survival after DLI: long interval between SCT and relapse, chronic CML phase at relapse, molecular or cytogenetic grade of relapse, low initial DLI cell dose and escalated-dose DLI regimen.…”

“…[6][7][8][9] However, only 58% of patients are estimated to be alive after 5 years following DLI, and the main causes of mortality are CML relapse and complications of this procedure. 6 A number of factors were shown to be related with improved survival after DLI: long interval between SCT and relapse, chronic CML phase at relapse, molecular or cytogenetic grade of relapse, low initial DLI cell dose and escalated-dose DLI regimen. 6,7,[10][11][12][13][14][15] However, the majority of analyses regarding DLI in CML have been performed based on data of patients transplanted more than a decade ago, when most patients received a BM graft.…”