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Immunotherapy following relapse of acute leukaemia after T‐cell‐replete allogeneic peripheral blood progenitor cell transplantation: importance of new onset chronic graft‐versus‐host disease
Author(s) -
Curley C.,
Hill G. R.,
McLean A.,
Kennedy G.A.
Publication year - 2014
Publication title -
international journal of laboratory hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.705
H-Index - 55
eISSN - 1751-553X
pISSN - 1751-5521
DOI - 10.1111/ijlh.12153
Subject(s) - medicine , fludarabine , immunosuppression , transplantation , graft versus host disease , univariate analysis , hematopoietic stem cell transplantation , immunotherapy , gastroenterology , oncology , immunology , multivariate analysis , chemotherapy , cyclophosphamide , cancer
Summary Introduction To further define the relative impact of immunotherapy and subsequent development of graft‐versus‐host disease ( GVHD ) on survival in patients with relapsed acute leukaemia postallogeneic hematopoietic stem cell transplant ( SCT ), we performed a single‐centre retrospective analysis of 32 actively treated patients between 2003 and 2011. Methods A total of 13 patients were identified who were treated actively with cessation of immunosuppression ± Fludarabine, Cytarabine, G‐CSF ( FLAG ) induction, but no donor leucocyte infusion ( DLI ) (non‐ DLI group) and 19 patients received the same step‐wise therapy plus G‐ CSF mobilized DLI (G‐ DLI group). Results Groups were not statistically different with regards to baseline characteristics; however, the G‐ DLI group contained more sibling donors as opposed to unrelated donors than the non‐ DLI group. With a median follow‐up of 47 months, the median overall survival ( OS ) of the non‐ DLI and G‐ DLI groups was not statistically different (8 months vs . 9 months, respectively, P = 0.5). Survival at 3 years was <10% in both groups. Univariate analysis identified response to FLAG , and new onset chronic GVHD as the only factors associated with improved OS . Conclusion Second donor stem cell infusions are unwarranted in the treatment of relapse after allogeneic SCT and therapeutic strategies should focus on cytoreduction followed by immune modulation with the aim of invoking chronic GVHD .