Prophylactic donor lymphocyte infusion for relapse prevention: a meta-analysis
Kittika Poonsombudlert1, Jakrin Kewcharoen1, Chattip Prueksapraopong2
1University of Hawaii, Internal Medicine Residency Program, Honolulu, HI, USA, and.
Japanese Journal of Clinical Oncology
|February 27, 2020
Summary
Prophylactic donor lymphocytes (pDLI) significantly reduce primary disease relapse after hematopoietic stem cell transplant (HSCT) without increasing graft-versus-host disease. This strategy also improves overall survival, offering a valuable approach for post-transplant relapse prevention.
Area of Science:
- Hematology
- Transplant Immunology
- Oncology
Background:
- Primary disease relapse (PDR) post-hematopoietic stem cell transplant (HSCT) remains a significant clinical challenge in malignant hematologic conditions.
- Prophylactic donor lymphocytes (pDLI) have been investigated for PDR prevention but yielded mixed results due to concerns about graft-versus-host disease (GVHD).
- Existing research necessitates a comprehensive evaluation of pDLI's efficacy and safety in reducing PDR and improving survival.
Purpose of the Study:
- To conduct a meta-analysis evaluating the association between prophylactic donor lymphocyte (pDLI) infusion and primary disease relapse (PDR) after HSCT.
- To assess the impact of pDLI on acute graft-versus-host disease (aGVHD) and overall survival (OS) in HSCT recipients.
- To determine the potential of pDLI as a strategy for preventing post-transplant relapse and improving patient outcomes.
Main Methods:
- A systematic literature search was performed across MEDLINE, Cochrane Library, and Embase databases up to May 2019.
- A random-effects meta-analysis included 9 studies with a total of 748 participants (398 in pDLI group, 350 in non-pDLI group).
- Pooled odds ratios (OR) were calculated to assess the association of pDLI with PDR, aGVHD, and OS.
Main Results:
- A significant reduction in the odds of PDR was observed in the pDLI group (pooled OR = 0.42, 95% CI 0.30-0.58).
- No statistically significant increase in the odds of aGVHD was found (pooled OR = 0.98, 95% CI 0.56-1.72).
- The pDLI group showed significantly increased odds of overall survival (OS) (pooled OR = 3.17, 95% CI 1.85-5.45).
Conclusions:
- Prophylactic donor lymphocyte (pDLI) infusion is associated with significantly decreased primary disease relapse (PDR) after HSCT.
- pDLI administration did not lead to a statistically significant increase in acute graft-versus-host disease (aGVHD).
- The findings suggest pDLI is a potentially valuable and effective method for preventing post-transplant relapse and improving overall survival.
