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ctt-journal > Slesarchuk et al. (Abstract)

Slesarchuk et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 12
doi: 10.3205/ctt-2011-No12-abstract06

© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "5th Raisa Gorbacheva Memorial Meeting Hematopoietic Stem Cell Transplantation in Children and Adults", Saint Petersburg, Russia, September 18–20, 2011

Preliminary Program

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Donor lymphocyte infusions (DLI) as preemptive therapy and disease relapse prophylaxis in patients after allogeneic stem cell transplantation (allo-HSCT)

Olga A. Slesarchuk, Elena V. Semenova, Sergey N. Bondarenko, Elena V. Babenko, Maria A. Estrina, Ilya V. Kazantsev, Ludmila S. Zubarovskaya, Boris V. Afanasyev

R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, St. Petersburg, Russia

Correspondence: Olga A. Slesarchuk, R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, St. Petersburg Pavlov State Medical University 6/8, Tolstoy str., St. Petersburg, 197022, Russia, E-mail: cadet2002@spam is badmail.ru

Abstract

Aim: To evaluate the efficacy of preemptive and prophylaxis DLI in patients (pts) with hematological malignances after allo-HSCT.

Methods: We conducted retrospective analysis of data from 28 pts with different hematological malignances: ALL (n=12), AML (n=6), acute biphenotypic leukemia (n=2), CML (n=5), and MDS (n=3). The median pt age was 21.9 (range 1–53) years. At the time of allo-HSCT 11 pts had CR, 7 pts had minimal residual disease (MRD), and 10 were in relapse or an acceleration phase. Nine pts received allo-HSCT from matched related, 14 from matched unrelated, and 5 from haploidentical donors. Ten and 18 patients received myeloablative and reduced intensity conditioning respectively. The indications for DLI were MRD in 11 pts (MRD was detected by cytogenetic method, PCR or flow-cytometry), falling chimerism in 8 pts, and disease relapse prophylaxis in 9 pts in the high-risk group. Thirteen pts received DLI in combination with tyrosine kinase inhibitors, IFN-gamma, IL-2, GM-CSF, and 15 pts received DLI alone. Fifteen pts received DLI by a bulk dose regimen (total cell dose (TCD) ranged from 1х104 to 8х107 CD3+/kg), and 13 an escalating dose regimen (TCD ranged from 2х105 to 1.2х108 CD3+/kg).

Results: Eight (72%) pts with MRD achieved MRD-negative status after DLI, and 1 pt relapsed 12 months after DLI. Full donor chimerism was achieved in 4 pts (50%). The duration of CR in pts who received prophylactic DLI was 6–16 months, and 2 pts developed disease relapse. Acute graft versus host disease (GVHD) grade III–IV occurred in 3 pts, and in 2 pts it was fatal. Chronic GVHD occurred in 11 pts. Five-yr OS was 73%. At the time of follow-up 21 pts are alive, including 18 in CR.

Conclusions: DLI is an effective method of preemptive therapy and disease relapse prophylaxis in pts with hematological malignancies after allo-HSCT; however, it may be associated with severe acute GVHD. Prophylaxis and preemptive DLI regimens need further investigation.   

Keywords: HSCT, leukemia, preemptive therapy, prophylaxis, donor lymphocyte infusion