Prophylactic Versus Preemptive Donor Lymphocyte Infusion in Refractory/Relapsed AML Post-Allogeneic Transplant: A...

Area of Science:

• Hematology
• Immunology
• Oncology

Background:

• Donor lymphocyte infusion (DLI) is a standard method for preventing relapse post-allogeneic hematopoietic stem cell transplantation (allo-HSCT).
• Comparing early prophylactic DLI (Pro-DLI) with preemptive DLI (Pre-DLI) triggered by measurable residual disease (MRD) is crucial for optimizing outcomes in acute leukemia.

Purpose of the Study:

• To compare the efficacy of prophylactic DLI versus preemptive DLI in preventing relapse after allo-HSCT for acute leukemia.
• To evaluate the impact of Pro-DLI and Pre-DLI on leukemia-free survival (LFS), cumulative incidence of relapse (CIR), and other clinical outcomes.

Main Methods:

• Retrospective analysis of 64 patients receiving Pro-DLI (early, in remission) and 84 patients receiving Pre-DLI (MRD-triggered) post-allo-HSCT for acute leukemia.
• Comparison of 2-year LFS, CIR, acute and chronic graft-versus-host disease (GVHD), non-relapse mortality (NRM), and overall survival (OS) between the two groups.

Main Results:

• The Pro-DLI cohort showed significantly higher 2-year LFS (56.3% vs. 40.5%, P = .045) and lower 2-year CIR (23.4% vs. 48.8%, P < .001) compared to the Pre-DLI cohort.
• Pro-DLI was associated with a higher incidence of chronic GVHD (64.1% vs. 40.5%, P < .001).
• No significant differences were observed in acute GVHD, NRM, or OS between the Pro-DLI and Pre-DLI groups.

Conclusions:

• Early prophylactic DLI significantly enhances relapse prevention and long-term leukemia-free survival in patients with refractory/relapsed acute leukemia undergoing allo-HSCT.
• Prophylactic DLI offers a superior strategy for relapse management compared to MRD-triggered preemptive DLI, despite a higher risk of chronic GVHD.