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Re: Prophylactic versus preemptive modified donor lymphocyte infusion for high-risk acute leukemia after allogeneic hematopoietic stem cell transplantation: a multicenter retrospective study

Bone Marrow Transplantation volume 59, pages 435–436 (2024)Cite this article

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We read with interest the study by Luxin Yang et al. [1], comparing the outcomes of patients treated with prophylactic donor lymphocyte infusion (pro-DLI) or preemptive DLI (pre-DLI). They found a very interesting result that pro-DLI, compared with pre-DLI, yields superior progression-free survival. The authors concluded that “early scheduled pro-DLI achieves higher survival and lower cumulative incidence of relapse, without increasing risk of GVHD and non-relapse mortality, compared with pre-DLI” (first part, which is technically correct), and that “it is recommended to administer pro-DLI after 90 days post-HSCT in high-risk patients without a history of severe GVHD” (second part), which is not entirely based on their own results. A similar analysis has been recently performed by an EBMT study [2].

Therefore, we would like to know if the results would hold if pro-DLI, treated preferentially as a time-dependent variable, were compared with patients who were observed. To make this comparison fair, only patients with negative MRD should be included. Because of the way the study was designed, we can not be sure whether the improved results in the pro-DLI-exposed group are due to better disease control with pro-DLI or a disproportionately lower prevalence of MRD+ patients.

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Fig. 1: Study design.

References

  1. Yang L, Lai X, Yang T, Lu Y, Liu L, Shi J et al. Prophylactic versus Preemptive modified donor lymphocyte infusion for high-risk acute leukemia after allogeneic hematopoietic stem cell transplantation: a multicenter retrospective study. Bone Marrow Transpl. 2023. https://doi.org/10.1038/s41409-023-02137-7.

  2. Schmid C, Labopin M, Schaap N, Veelken H, Brecht A, Stadler M, et al. Long-term results and GvHD after prophylactic and preemptive donor lymphocyte infusion after allogeneic stem cell transplantation for acute leukemia. Bone Marrow Transpl. 2022;57:215–23.

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  3. Aguayo-Orozco A, Haue AD, Jørgensen IF, Westergaard D, Moseley PL, Mortensen LH, et al. Optimizing drug selection from a prescription trajectory of one patient. npj Digit Med. 2021;4:150.

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  1. Academic Research Organization, Hospital Israelita Albert Einstein, Sao Paulo, Brazil

    Leonardo Javier Arcuri

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LJA conducted this work, wrote the manuscript and performed all analyses.

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Correspondence to Leonardo Javier Arcuri.

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Arcuri, L.J. Re: Prophylactic versus preemptive modified donor lymphocyte infusion for high-risk acute leukemia after allogeneic hematopoietic stem cell transplantation: a multicenter retrospective study. Bone Marrow Transplant 59, 435–436 (2024). https://doi.org/10.1038/s41409-023-02186-y

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