Minimal residual disease- and graft-vs.-host disease-guided multiple consolidation chemotherapy and donor lymphocyte infusion prevent second acute leukemia relapse after allotransplant.

Abstract

BACKGROUND:

Persons with acute leukemia relapsing after allotransplant and who respond to anti-leukemia interventions are at high risk of a second relapse. We studied the impact of minimal residual disease (MRD)- and graft-vs.-host disease (GvHD)-guided multiple consolidation chemotherapy and donor lymphocyte infusions (DLIs) to prevent second relapse in patients with acute leukemia relapsing post-transplant and who achieved complete remission after induction chemotherapy and DLI.

METHODS:

Forty-seven subjects with acute leukemia relapsing after an allotransplant and who achieved complete remission after post-relapse induction chemotherapy and DLI were eligible. The use of consolidation chemotherapy and DLI was guided by the results of MRD testing and whether or not DLI caused acute and/or chronic GvHD. Outcomes were compared with those of 34 similar historical controls who did not receive consolidation chemotherapy and DLIs after induction chemotherapy and DLI.

RESULTS:

One-year cumulative incidence of relapse (CIR; 22 % 95 % confidence interval (10, 35 %) vs. 56 % (39, 73 %); P < 0.0001), leukemia-free survival (LFS; 71 % (57, 84 %) vs. 35 % (19, 51 %); P < 0.0001), and survival (78 % (66, 90 %) vs. 44 % (27, 61 %); P < 0.0001) was significantly better in subjects than controls. In multivariate analyses, no chronic GvHD after therapy (hazard ratio (HR) = 3.56 (1.09, 11.58); P = 0.035) and a positive MRD test after therapy (HR = 21.04 (4.44, 94.87); P < 0.0001) were associated with an increased CIR.

CONCLUSION:

These data suggest MRD- and GvHD-guided multiple consolidation chemotherapy and DLIs reduce CIR and increase LFS and survival compared with controls in persons relapsing after allotransplant for acute leukemia.

TRIAL REGISTRATION:

ChiCTR-ONC-12002912 . Donor lymphocyte infusion for the treatment of leukemia relapse following allogeneic hematopoeitic stem cell transplant.

• Authors: Chen-Hua Yan, Yu Wang, Jing-Zhi Wang, Yu-Hong Chen, Yao Chen, Feng-Rong Wang, Yu-Qian Sun, Xiao-Dong Mo, Wei Han, Huan Chen, Xiao-Hui Zhang, Lan-Ping Xu, Kai-Yan Liu, Xiao-Jun Huang
• Journal: Journal of hematology & oncology (J Hematol Oncol) Vol. 9 Issue 1 Pg. 87 (09 15 2016) ISSN: 1756-8722 [Electronic] England
• PMID: 27629395 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Acute Disease
• Adolescent
• Adult
• Case-Control Studies
• Child
• Child, Preschool
• Consolidation Chemotherapy (methods)
• Female
• Graft vs Host Disease (etiology)
• Humans
• Leukemia (complications, mortality, therapy)
• Lymphocyte Transfusion (adverse effects)
• Male
• Middle Aged
• Neoplasm, Residual (diagnosis)
• Neoplasms, Second Primary
• Recurrence
• Secondary Prevention
• Survival Analysis
• Transplantation, Homologous
• Young Adult