期刊
CANCER MEDICINE
卷 10, 期 10, 页码 3165-3176出版社
WILEY
DOI: 10.1002/cam4.3763
关键词
allogeneic peripheral blood stem cell transplantation; decitabine; donor lymphocyte infusion; relapse; unfavourable gene mutations
类别
资金
- National Natural Science Foundation of China [81270610, 81770203, 30800482, 81800135]
- Capital's Funds for Health Improvement and Research [2016-1-4082]
- Capital Public Health Project
- National Key Clinical Specialized Military Construction Project
The study demonstrated the feasibility of prophylactic DLI with/without decitabine in the early stage post-allo-HSCT in patients with unfavourable gene mutations. Significant associations were found between acute GVHD and relapse after DLI with inferior overall survival.
Relapse is the main cause of treatment failure for leukaemia patients with unfavourable gene mutations who receive allogeneic haematopoietic stem cell transplantation (allo-HSCT). There is no consensus on the indication of donor lymphocyte infusion (DLI) for prophylaxis of relapse after allo-HSCT. To evaluate the tolerance and efficacy of prophylactic DLI in patients with unfavourable gene mutations such as FLT3-ITD, TP53, ASXL1, DNMT3A or TET2, we performed a prospective, single-arm study. Prophylactic use of decitabine followed by DLI was planned in patients with TP53 or epigenetic modifier gene mutations. The prophylaxis was planned in 46 recipients: it was administered in 28 patients and it was not administered in 18 patients due to contraindications. No DLI-associated pancytopenia was observed. The cumulative incidences of grade II-IV and III-IV acute graft-versus-host disease (GVHD) at 100 days post-DLI were 25.8% and 11.0%, respectively. The rates of chronic GVHD, non-relapse mortality and relapse at 3 years post-DLI were 21.6%, 25.0% and 26.1%, respectively. The 3-year relapse-free survival and overall survival (OS) rates were 48.9% and 48.2%, respectively. Acute GVHD (HR: 2.30, p = 0.016) and relapse (HR: 2.46, p = 0.003) after DLI were independently associated with inferior OS. Data in the current study showed the feasibility of prophylactic DLI with/without decitabine in the early stage after allo-HSCT in patients with unfavourable gene mutations.
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