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Chemotherapy plus DLI for relapse after haploidentical HSCT: the biological characteristics of relapse influences clinical outcomes of acute leukemia patients

Bone Marrow Transplantation (2018) | Download Citation

Abstract

This study investigated the prognostic factors in patients (n = 89) who experienced relapse and received chemotherapy plus donor leukocyte infusion (Chemo-DLI) after haploidentical hematopoietic stem cell transplantation (haplo-HSCT). Patients with early relapse (< 6 vs. > 6 months after haplo-HSCT), higher bone marrow blast count before chemo-DLI (> 20% vs. 5–19%), and without chronic graft-versus-host disease (cGVHD) after chemo-DLI had a higher rate of progressive disease (PD) and worse progression-free survival (PFS) and overall survival (OS). In multivariate analysis, non-cGVHD after Chemo-DLI and high blast count predicted a higher risk of PD and poorer PFS, and non-cGVHD after Chemo-DLI and early relapse predicted poorer OS. The patients were stratified into three groups according to these three risk factors. Patients with all three risk factors (n = 14) had the highest PD rate and poorest survival compared with those with one or two risk factors (n = 63) or no risk factors (n = 12). Thus, early relapse, high leukemia burden before Chemo-DLI, and non-cGVHD after Chemo-DLI can predict outcomes in patients who have experienced relapse and received Chemo-DLI after haplo-HSCT. New therapeutic strategies should be identified for these patients.

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Acknowledgements

This work was supported by the Capital’s Funds for Health Improvement and Research (grant number 2018–4–4089), the Key Program of the National Natural Science Foundation of China (grant number 81530046), the Foundation for Innovative Research Groups of the National Natural Science Foundation of China (grant number 81621001), the Science and Technology Project of Guangdong Province of China (grant number 2016B030230003), and the project of health collaborative innovation of Guangzhou city (grant number. 201704020214).

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Author notes

  1. These authors contributed equally: Wei Sun, Xiao-Dong Mo

Affiliations

  1. Peking University People’s Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

    • Wei Sun
    • , Xiao-Dong Mo
    • , Xiao-Hui Zhang
    • , Lan-Ping Xu
    • , Yu Wang
    • , Chen-Hua Yan
    • , Huan Chen
    • , Yu-Hong Chen
    • , Wei Han
    • , Feng-Rong Wang
    • , Jing-Zhi Wang
    • , Kai-Yan Liu
    •  & Xiao-Jun Huang
  2. Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China

    • Xiao-Jun Huang

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The authors declare that they have no conflict of interest.

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Correspondence to Xiao-Jun Huang.

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DOI

https://doi.org/10.1038/s41409-018-0406-z