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Donor lymphocyte infusions and second transplantation as salvage treatment for relapsed myelofibrosis after reduced‐intensity allografting
Author(s) -
Klyuchnikov Evgeny,
Holler Ernst,
Bornhäuser Martin,
Kobbe Guido,
Nagler Ar,
Shimoni Avichai,
Könecke Christian,
Wolschke Christine,
Bacher Ulrike,
Zander Axel R.,
Kröger Nicolaus
Publication year - 2012
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.12013
Subject(s) - medicine , donor lymphocyte infusion , cumulative incidence , myelofibrosis , surgery , transplantation , gastroenterology , incidence (geometry) , hematopoietic stem cell transplantation , graft versus host disease , bone marrow , physics , optics
Summary Thirty myelofibrosis patients (21 males, nine females) with relapse ( n = 27) or graft‐rejection ( n = 3) after dose‐reduced allografting underwent a salvage strategy including donor lymphocyte infusions ( DLI s) and/or second allogeneic haematopoietic stem cell transplantation ( HSCT ). Twenty‐six patients received a median number of three (range, 1–5) DLI s in a dose‐escalated mode starting with a median dose of 1·2 × 10 6 (range, 0·003–8 × 10 6 ) up to median dose of 40 × 10 6 T ‐cells/kg (range, 10–130 × 10 6 ). 10/26 patients (39%) achieved complete response ( CR ) to DLI s. Acute (grade II ‐ IV ) and chronic graft‐ versus ‐host ( GvHD ) disease occurred in 12% and 36% cases. Thirteen non‐responders to DLI and four patients who did not receive DLI due to graft‐rejection or acute transformation of the blast phase underwent a second allogeneic HSCT from alternative ( n = 15) or the same ( n = 2) donor. One patient (6%) experienced primary graft‐failure and died. Acute ( II ‐ IV ) and chronic Gv HD were observed in 47% and 46% of patients. Overall responses after second HSCT were seen in 12/15 patients (80%: CR : n = 9, partial response: n = 3). The 1‐year cumulative incidence of non‐relapse mortality for recipients of a second allograft was 6%, and the cumulative incidence of relapse was 24%. After a median follow‐up of 27 months, the 2‐year overall survival and progression‐free survival for all 30 patients was 70% and 67%, respectively. In conclusion, our two‐step strategy, including DLI and second HSCT for non‐responding or ineligible patients, is an effective and well‐tolerated salvage approach for patients relapsing after reduced‐intensity allograft after myelofibrosis.