Changes in donor lymphocyte infusion for relapsed patients post-hematopoietic stem cell transplantation: a 30-year single-center experience.

IF 5.9 2区医学 Q1 IMMUNOLOGY Frontiers in Immunology Pub Date : 2025-01-29 eCollection Date: 2025-01-01 DOI:10.3389/fimmu.2025.1521895

Yusuke Uchibori, Shuhei Kurosawa, Yuho Najima, Kyoko Haraguchi, Daichi Sadato, Chizuko Hirama, Yasutaka Sadaga, Kaori Kondo, Chika Kato, Satoshi Sakai, Yasuhiro Kambara, Fumihiko Ouchi, Masashi Shimabukuro, Atsushi Jinguji, Naoki Shingai, Takashi Toya, Hiroaki Shimizu, Takeshi Kobayashi, Hironori Harada, Yuka Harada, Yoshiki Okuyama, Noriko Doki

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Abstract

Introduction: Donor lymphocyte infusion (DLI) is a therapeutic approach for relapse after hematopoietic stem cell transplantation (HSCT). Despite their reported efficacy, the evolution of DLI practices over time remains underexplored.

Methods: This study provided a comprehensive analysis of DLI strategies and outcomes over 30 years at a single institution. A retrospective analysis was conducted on 75 patients who underwent DLI for disease relapse between April 1994 and March 2024. The primary endpoint was the 3-year overall survival (OS) rate after DLI. Secondary endpoints included the 100-day complete remission (CR) rate and incidence of acute graft-versus-host disease (GVHD).

Results: The median age at the first DLI was 49 years (range, 20-69 years). The most common underlying diseases in all 75 cases were acute myeloid leukemia (AML, n = 46) and myelodysplastic syndromes (MDS, n = 12). Until 2014, DLI was only performed in patients with AML (n = 14), MDS (n = 2), or chronic myeloid leukemia (n = 5). However, since 2015, patients with various diseases, including lymphoid malignancies, have also undergone DLI. Azacitidine was the most frequently used combination therapy with DLI (n = 34). Regimens including venetoclax and FLT3 inhibitors have been commonly used since 2019 (n = 18). The 3-year OS rate was 29.1% (95% CI, 18.8-40.2%). Factors negatively influencing OS included age ≥50 years and a high or very high refined disease risk index. The 100-day CR rate was 52.1%, and acute GVHD occurred in 25.3% of the patients, with no strong correlation between GVHD incidence and CR achievement. Among 18 patients who underwent three or more DLIs since 2018, 88.9% achieved remission following DLI or second HSCT, with a median follow-up of 949.5 days for survivors.

Conclusion: This study highlighted the evolving trends in DLI practices and the diversification of combination therapies. Future research should focus on further validating these findings and optimizing DLI protocols to improve patient outcomes.

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造血干细胞移植后复发患者供体淋巴细胞输注的变化：30年单中心研究

供体淋巴细胞输注（DLI）是一种治疗造血干细胞移植（HSCT）后复发的方法。尽管报道了它们的功效，但随着时间的推移，DLI实践的演变仍未得到充分探索。方法：本研究提供了一个单一机构30年来DLI策略和结果的综合分析。回顾性分析了1994年4月至2024年3月间因疾病复发而接受DLI治疗的75例患者。主要终点是DLI后的3年总生存率（OS）。次要终点包括100天完全缓解（CR）率和急性移植物抗宿主病（GVHD）发生率。结果：首次DLI的中位年龄为49岁（范围20-69岁）。所有75例患者中最常见的基础疾病是急性髓性白血病（AML, n = 46）和骨髓增生异常综合征（MDS, n = 12）。直到2014年，DLI仅在AML （n = 14）、MDS （n = 2）或慢性髓系白血病（n = 5）患者中进行。然而，自2015年以来，包括淋巴细胞恶性肿瘤在内的各种疾病患者也进行了DLI。阿扎胞苷是最常用的与DLI联合治疗（n = 34）。自2019年以来，常用的治疗方案包括venetoclax和FLT3抑制剂（n = 18）。3年OS率为29.1% （95% CI, 18.8-40.2%）。负面影响OS的因素包括年龄≥50岁和高或非常高的精细疾病风险指数。100天CR率为52.1%，急性GVHD发生率为25.3%，GVHD发生率与CR实现无强相关性。在2018年以来接受三次或更多DLI的18例患者中，88.9%的患者在DLI或第二次HSCT后获得缓解，幸存者的中位随访时间为949.5天。结论：本研究突出了DLI实践的发展趋势和联合治疗的多样化。未来的研究应侧重于进一步验证这些发现并优化DLI方案以改善患者的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Immunology IMMUNOLOGY-

CiteScore

9.80

自引率

11.00%

发文量

7153

审稿时长

14 weeks

期刊介绍： Frontiers in Immunology is a leading journal in its field, publishing rigorously peer-reviewed research across basic, translational and clinical immunology. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. Frontiers in Immunology is the official Journal of the International Union of Immunological Societies (IUIS). Encompassing the entire field of Immunology, this journal welcomes papers that investigate basic mechanisms of immune system development and function, with a particular emphasis given to the description of the clinical and immunological phenotype of human immune disorders, and on the definition of their molecular basis.