CD34 Chimerism Directed Donor Lymphocyte Infusion With or Without Azacitidine Results in Reduced Relapse and Superior Overall Survival When Full Donor Chimerism is Achieved in Allogeneic Stem Cell Transplant Recipients With Acute Myeloid Leukaemia/Myelodysplastic Syndrome.

Autor: Tan JL; Department of Malignant Haematology, Transplantation and Cellular Therapies, The Alfred Hospital, Victoria, Australia. Electronic address: joa.tan@alfred.org.au., Curtis DJ; Department of Malignant Haematology, Transplantation and Cellular Therapies, The Alfred Hospital, Victoria, Australia., Muirhead J; Department of Malignant Haematology, Transplantation and Cellular Therapies, The Alfred Hospital, Victoria, Australia., Swain MI; Department of Malignant Haematology, Transplantation and Cellular Therapies, The Alfred Hospital, Victoria, Australia., Fleming SA; Department of Malignant Haematology, Transplantation and Cellular Therapies, The Alfred Hospital, Victoria, Australia., Cirone B; Department of Malignant Haematology, Transplantation and Cellular Therapies, The Alfred Hospital, Victoria, Australia., O'Brien ME; Department of Malignant Haematology, Transplantation and Cellular Therapies, The Alfred Hospital, Victoria, Australia., Wong SM; Department of Malignant Haematology, Transplantation and Cellular Therapies, The Alfred Hospital, Victoria, Australia., Inam S; Department of Malignant Haematology, Transplantation and Cellular Therapies, The Alfred Hospital, Victoria, Australia., Patil S; Department of Malignant Haematology, Transplantation and Cellular Therapies, The Alfred Hospital, Victoria, Australia., Spencer A; Department of Malignant Haematology, Transplantation and Cellular Therapies, The Alfred Hospital, Victoria, Australia.
Jazyk: angličtina
Zdroj: Clinical lymphoma, myeloma & leukemia [Clin Lymphoma Myeloma Leuk] 2024 Nov; Vol. 24 (11), pp. e852-e860. Date of Electronic Publication: 2024 Jul 20.
DOI: 10.1016/j.clml.2024.07.006
Abstrakt: Background: Regular monitoring of CD34 donor chimerism (DC) is a highly sensitive method of predicting relapse in allogeneic stem cell transplant (alloHSCT) recipients with AML/MDS. A fall of CD34 DC below 80% is an indicator of ensuing relapse. There are limited studies assessing the efficacy of donor lymphocyte infusion (DLI) triggered by mixed CD34 DC (MDC), in addressing falling chimerism.
Patients and Methods: We performed a retrospective analysis of consecutive alloHSCT patients between 2012 to 2023 who received DLI (with or without azacitidine) for CD34 MDC without morphologic relapse at the time of infusion.
Results: Of the 21 patients with follow up CD34 DC available, 14 (66.7%) achieved CD34 full donor chimerism (FDC) following DLI with or without azacitidine (dli-FDC), while 7 (33.3%) did not (dli-MDC). The 2-year cumulative incidence of relapse (CIR) was significantly lower in dli-FDC compared to dli-MDC (21.4% vs. 85.7%, P < 0.001), correlating with superior overall survival (OS; median years not reached vs. 0.67 years [95% CI, 0.58-ND], P < .001). Rates of grade II-IV acute GVHD post-DLI were 14.9%, and moderate-severe cGVHD was 42.8% in the dli-FDC group. The 5-year nonrelapse mortality (NRM) of the dli-FDC group was 7.1% following DLI.
Conclusion: Our study shows the restoration of CD34 FDC post-DLI is associated with reduced relapse and improved overall survival, with low NRM.
Competing Interests: Disclosure All authors listed above do not have any conflicts of interest to disclose.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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