The Role of Donor Lymphocyte Infusion (DLI) in Post-Hematopoietic Cell Transplant (HCT) Relapse for Chronic Myeloid Leukemia (CML) in the Tyrosine Kinase Inhibitor (TKI) Era. Biol Blood Marrow Transplant 2020 Jun;26(6):1137-1143
Date
02/18/2020Pubmed ID
32062061Pubmed Central ID
PMC7367282DOI
10.1016/j.bbmt.2020.02.006Scopus ID
2-s2.0-85081933393 (requires institutional sign-in at Scopus site) 13 CitationsAbstract
Treatment for relapse of chronic myeloid leukemia (CML) following hematopoietic cell transplantation (HCT) includes tyrosine kinase inhibitors (TKIs) with or without donor lymphocyte infusions (DLIs), but the most effective treatment strategy is unknown. This study was performed through the Center for International Blood and Marrow Transplant Research (CIBMTR) database. We retrospectively reviewed all patients reported to the CIBMTR registry from 2002 to 2014 who underwent HCT for CML and were alive 30 days postrelapse. A total of 215 HCT recipients relapsed and were analyzed in the following groups: (1) TKI alone (n = 128), (2) TKI with DLI (n = 48), and (3) DLI without TKI (n = 39). In multivariate analysis, disease status prior to HCT had a significant effect on overall survival (OS). Patients who received a DLI alone compared with a TKI with a DLI had inferior survival (hazard ratio, 2.28; 95% confidence interval, 1.23 to 4.24; P= .009). Those who received a TKI alone had similar survival compared with those who received a TKI with a DLI (P = .81). These data support that despite use of TKIs pretransplantation, TKI salvage therapy continues to provide significant survival following relapse in patients with CML following HCT. These data do not suggest that adding a DLI to a TKI adds an improvement in OS.
Author List
Schmidt S, Liu Y, Hu ZH, Williams KM, Lazarus HM, Vij R, Kharfan-Dabaja MA, Ortí G, Wiernik PH, Weisdorf D, Kamble RT, Herzig R, Wirk B, Cerny J, Bacher U, Chaudhri NA, Nathan S, Farhadfar N, Aljurf M, Gergis U, Szer J, Seo S, Hsu JW, Olsson RF, Maharaj D, George B, Hildebrandt GC, Agrawal V, Nishihori T, Abdel-Azim H, Alyea E, Popat U, Sobecks R, Scott BL, Holter Chakrabarty J, Saber WAuthor
Wael Saber MD, MS Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Hematopoietic Stem Cell TransplantationHumans
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Lymphocyte Transfusion
Lymphocytes
Protein Kinase Inhibitors
Recurrence
Retrospective Studies