Contributions
Abstract: PB1798
Type: Publication Only
Session title: Stem cell transplantation - Clinical
Background
Despite improvements in stem cell transplantation of patients with acute leukemia, relapse is still one of the main causes of mortality. DLI is one of the strategies used in high risk patients, allowing us to rescue 30-55% of the patients. It also reduces risk 2.3 times when it is used as a preemptive strategy.
Aims
Analyse our experience in the use of DLI as a prophylaxis, preemptive or treatment strategy.
Methods
A retrospective cohort study was performed among adult recipients of allogeneic HSCT between 2016 and 2019 who subsequently underwent DLI as a prophylaxis, preemptive or treatment strategy.
Results
A total of 10 patients were included. The median age was 52 (24-69), 70% were women (7) and 30% men (3). Underlying diseases: 7 Acute Myeloid Leukemia (70%), 2 Acute Lymphoid Leukemia (20%) and 1 Myelodysplastic Syndrome (10%). Patients received ASCT from related HLA-identical (10%), haploidentical (80%) and unrelated donors (10%). Disease status prior HSCT: 2 persistent disease (20%), 7 complete response (CR), 4 of them presented negative minimal residual disease (MRD) and the other 3 had positive MRD (molecular, cytogenetics or immunophenotypic markers). 1 patient with MDS had not received any previous treatment. At day +30: 90% presented CR, 4 of them complete chimerism (CC) and the other 6 mixed chimerism (MC). The patient with MDS presented persistent disease. One of the patients underwent a 2nd alloHSCT and received DLI after both transplants.
The median time for immunesuppressive treatment’s interruption was 91 days (45-147). The median time to DLI indication was 137 days (114-475). The indications for DLI were: 4 (36.4%) as treatment (3 relapse diseases and 1 refractory), 4 (34.4%) prophylaxis because of high risk disease and 3 (27.2%) preemptive because of positive MRD or CC. The median DLI dose was 3 (1-4).
In the treatment group, 75% received DLI in combination with Azacitidine (1 of them in combination with Sorafenib) and 1 in monotherapy. In the prophylaxis group, 50% received it in combination with azacitidine and sorafenib or sorafenib only and the other 50% in monotherapy. In the preemptive group, 67% in combination with Azacitidine and 33% in monotherapy.
Related to response after DLI, in the treatment group: 75% refractory, 25% CR with positive MRD and MC. In prophylaxis group: 75% CR, negative MDR and CC, 25% CR and MC. In preemptive group: 67% CR, negative MRD and CC, 33% negative MRD and MC.
Therefore, 45.4% of all patients achieved CR, negative MRD and CC and the other 27.3% presented refractoriness.
GVHD rate was 50%. After a median time of follow-up of 4 years (1-4), 40% are still in remission. 4 patients died, 2 of them due to relapse (20%) and the other two because of infections
Conclusion
DLI represents an useful and safe preemptive and prophylactic strategy in patients with high risk of relapse. We achieved remission in 30-40% of patients. On the other hand, there was a limited response in patients with treatment indication, being necessary to individualize and to associate targeted therapies. In most of these cases, it has been necessary the use of intensive therapies with a decrease in survival.
Keyword(s): Allogeneic hematopoietic stem cell transplant, Cellular therapy, Relapsed acute myeloid leukemia
Abstract: PB1798
Type: Publication Only
Session title: Stem cell transplantation - Clinical
Background
Despite improvements in stem cell transplantation of patients with acute leukemia, relapse is still one of the main causes of mortality. DLI is one of the strategies used in high risk patients, allowing us to rescue 30-55% of the patients. It also reduces risk 2.3 times when it is used as a preemptive strategy.
Aims
Analyse our experience in the use of DLI as a prophylaxis, preemptive or treatment strategy.
Methods
A retrospective cohort study was performed among adult recipients of allogeneic HSCT between 2016 and 2019 who subsequently underwent DLI as a prophylaxis, preemptive or treatment strategy.
Results
A total of 10 patients were included. The median age was 52 (24-69), 70% were women (7) and 30% men (3). Underlying diseases: 7 Acute Myeloid Leukemia (70%), 2 Acute Lymphoid Leukemia (20%) and 1 Myelodysplastic Syndrome (10%). Patients received ASCT from related HLA-identical (10%), haploidentical (80%) and unrelated donors (10%). Disease status prior HSCT: 2 persistent disease (20%), 7 complete response (CR), 4 of them presented negative minimal residual disease (MRD) and the other 3 had positive MRD (molecular, cytogenetics or immunophenotypic markers). 1 patient with MDS had not received any previous treatment. At day +30: 90% presented CR, 4 of them complete chimerism (CC) and the other 6 mixed chimerism (MC). The patient with MDS presented persistent disease. One of the patients underwent a 2nd alloHSCT and received DLI after both transplants.
The median time for immunesuppressive treatment’s interruption was 91 days (45-147). The median time to DLI indication was 137 days (114-475). The indications for DLI were: 4 (36.4%) as treatment (3 relapse diseases and 1 refractory), 4 (34.4%) prophylaxis because of high risk disease and 3 (27.2%) preemptive because of positive MRD or CC. The median DLI dose was 3 (1-4).
In the treatment group, 75% received DLI in combination with Azacitidine (1 of them in combination with Sorafenib) and 1 in monotherapy. In the prophylaxis group, 50% received it in combination with azacitidine and sorafenib or sorafenib only and the other 50% in monotherapy. In the preemptive group, 67% in combination with Azacitidine and 33% in monotherapy.
Related to response after DLI, in the treatment group: 75% refractory, 25% CR with positive MRD and MC. In prophylaxis group: 75% CR, negative MDR and CC, 25% CR and MC. In preemptive group: 67% CR, negative MRD and CC, 33% negative MRD and MC.
Therefore, 45.4% of all patients achieved CR, negative MRD and CC and the other 27.3% presented refractoriness.
GVHD rate was 50%. After a median time of follow-up of 4 years (1-4), 40% are still in remission. 4 patients died, 2 of them due to relapse (20%) and the other two because of infections
Conclusion
DLI represents an useful and safe preemptive and prophylactic strategy in patients with high risk of relapse. We achieved remission in 30-40% of patients. On the other hand, there was a limited response in patients with treatment indication, being necessary to individualize and to associate targeted therapies. In most of these cases, it has been necessary the use of intensive therapies with a decrease in survival.
Keyword(s): Allogeneic hematopoietic stem cell transplant, Cellular therapy, Relapsed acute myeloid leukemia