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Donor lymphocyte infusion after haploidentical hematopoietic stem cell transplantation for acute myeloid leukemia

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Abstract

Although haploidentical donor lymphocyte infusion (DLI) is a valid treatment option for relapsed acute myeloid leukemia (AML), the incidence and risk factors for graft-versus-host disease (GVHD) and the efficacy of haploidentical DLI have not been fully evaluated. We retrospectively analyzed the outcomes after haploidentical DLI for 84 patients with AML using a nationwide database and additional questionnaires. The median number of DLI cycles and infused CD3+ cell dose was 1 and 1.0 × 106/kg, respectively. The infused CD3+ cell count of 5.0 × 105/kg or higher was associated with acute GVHD (grade II–IV, 32.1% vs. 10.5%, p = 0.03; grade III–IV, 21.4% vs. 5.3%, p = 0.10). Patients who developed grade III–IV acute GVHD more frequently succumbed to treatment-related mortality (46.7% vs. 15.8% at 1 year, p = 0.002), although the relapse-related mortality was significantly low (40.0% vs. 72.2% at 1 year, p = 0.025). The overall response to DLI was significantly higher in the preemptive DLI group (47.4%) than in the therapeutic group (13.9%, p = 0.002). In the multivariate analysis, preemptive DLI was the predictive factor for overall response (odds ratio, 5.58; p = 0.003). Our results indicated the substantial risk of acute GVHD after haploidentical DLI with CD3+ cell count of 5.0×105/kg or higher and the favorable outcomes after preemptive DLI.

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Acknowledgments

We are grateful to all physicians and staff at the transplant centers who provided the clinical data to the Transplant Registry Unified Management Program of the Japan Society of Hematopoietic Cell Transplantation. We also express gratitude to the staff at the Japan Society of Hematopoietic Cell Transplantation and the Japanese Data Center for Hematopoietic Cell Transplantation for their dedication to the organization and management of the data.

Funding

This work was supported in part by the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from Japan Agency for Medical Research and Development, AMED under Grant Number 18ek0510023h0002.

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Correspondence to Kaito Harada.

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Informed consent was obtained from all participants for inclusion in this study. This retrospective study was approved by the data management committees of the Transplant Registry Unified Management Program and the Institutional Review Board of Tokai University School of Medicine.

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The authors declare no competing interests.

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Harada, K., Mizuno, S., Yano, S. et al. Donor lymphocyte infusion after haploidentical hematopoietic stem cell transplantation for acute myeloid leukemia. Ann Hematol 101, 643–653 (2022). https://doi.org/10.1007/s00277-021-04731-5

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