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Salvage chemotherapy followed by granulocyte colony‐stimulating factor‐primed donor leukocyte infusion with graft‐vs.‐host disease control for minimal residual disease in acute leukemia/myelodysplastic syndrome after allogeneic hematopoietic stem cell transplantation: prognostic factors and clinical outcomes
Author(s) -
Mo XiaoDong,
Zhang XiaoHui,
Xu LanPing,
Wang Yu,
Yan ChenHua,
Chen Huan,
Chen YuHong,
Han Wei,
Wang FengRong,
Wang JingZhi,
Liu KaiYan,
Huang XiaoJun
Publication year - 2016
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.12591
Subject(s) - medicine , minimal residual disease , donor lymphocyte infusion , hematopoietic stem cell transplantation , chemotherapy , granulocyte colony stimulating factor , gastroenterology , cumulative incidence , transplantation , oncology , leukemia
This study investigated the prognostic factors and clinical outcomes of preemptive chemotherapy followed by granulocyte colony‐stimulating factor‐primed donor leukocyte infusion (Chemo‐ DLI ) according to minimal residual disease ( MRD ) status in patients with acute leukemia and myelodysplastic syndromes who received allogeneic hematopoietic stem cell transplantation ( HSCT ) ( n = 101). Patients received immunosuppressive drugs to prevent graft‐vs.‐host disease ( GVHD ) after Chemo‐ DLI . The 3‐yr cumulative incidences of relapse, non‐relapse mortality, and disease‐free survival ( DFS ) after HSCT were 39.5%, 9.6%, and 51.7%, respectively. The cumulative incidences of relapse and DFS were significantly poorer in patients who exhibited early‐onset MRD . Forty‐four patients turned MRD negative 1 month after Chemo‐ DLI ; their cumulative incidences of relapse and DFS were significantly better than those with persistent MRD 1 month after preemptive Chemo‐ DLI (relapse: 19.8% vs. 46.8%, P = 0.001; DFS : 69.6% vs. 46.4%, P = 0.004). The cumulative incidences of relapse and DFS after HSCT were significantly better in patients with chronic GVHD ( cGVHD ) than those without cGVHD (relapse: 19.6% vs. 63.7%, P < 0.001; DFS : 74.4% vs. 23.8%, P < 0.001). Early‐onset MRD , persistent MRD after Chemo‐ DLI , and non‐ cGVHD after Chemo‐ DLI , which were associated with increased relapse and impaired DFS , suggest unsatisfactory response to preemptive Chemo‐DLI.