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Slesarchuk et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 9
doi: 10.3205/ctt-2010-No9-abstract47
© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "4th Raisa Gorbacheva Memorial Meeting on Hematopoietic Stem Cell Transplantation",
Saint Petersburg, Russia, September 18–20, 2010

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The role of donor lymphocyte infusions (DLI) following allogeneic stem cell transplantation (allo-HSCT) in patients with acute leukemia

Olga A. Slesarchuk, Elena V. Semenova, 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, Saint-Petersburg, Russia

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

Abstract

Purpose: To improve allo-HSCT results in patients (pts) with relapsed or resistant acute leukemia using DLI.

Patients and methods: We conducted a retrospective analysis of data from 52 leukemia pts (21 pts with AML and 31 with ALL) resistant to conventional therapy (n=12) or relapsed (n=40), who received DLI after allo-HSCT. The median pts age was 19.5 (1–54) years. 23 pts received allo-SCT from matched related (MRD), 19 from matched unrelated (MUD), and 10 from haploidentical donors. 20 patients received the MAC regimen, and 32 a RIC regimen. We divided relapsed patients into group A (n=23, underwent allo-SCT in CR), and group B (n=17, no CR at the time of SCT). 43 pts received DLI combined with chemotherapy, IL-2, IFN-gamma, GM-CSF, and 10 pts received DLI alone. Total cell dose (TCD) ranged from 1,24х104 CD3+cells/kg to 2х108 CD3+cells/kg. In 29 pts the TCD exceeded 5х106 CD3+cells/kg.

Results:
CR was achieved in 18 pts (34.6%): 10 pts (43.5%) in group A, 6 pts (35.3%) in group B, and 2 pts (16.7%) in the resistant leukemia group. With a median follow-up of 31.7 (3–53) months, 4-year OS was 17%, 2-year OS was 43% in group A, and 23% in group B. TCD > 5х106 CD3+cells/kg, MAC regimen and allo-SCT from MUD were associated with better outcome. Acute GVHD occurrence in the high TCD group was acceptable (13.8%). Two-year OS was higher in pts receiving DLI combined with chemotherapy or additional therapy (33%), than in pts, who received DLI alone (12%).

Conclusions: DLI with TCD exceeding 5х106 CD3+cells/kg in combination with chemotherapy or additional immunotherapy is a promising post allo-SCT treatment approach in patients with relapsed or resistant acute leukemia. This therapy provides best results after MAC regimen and allo-SCT from MUD. Associated aGVHD occurrence is acceptable.  

Keywords: HSCT, acute leukemia, relapse, resistance, donor lymphocyte infusion

 

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