Prophylactic donor lymphocyte infusions after first allogeneic hematopoietic stem cell transplantation in children
Ang Wei1,2,3,4,5, Chenguang Jia1,2,3,4,5, Guanghua Zhu1,2,3,4,5
1Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, 100045, China.
Insights
Prophylactic donor lymphocyte infusion (DLI) after allogeneic hematopoietic stem cell transplantation (HSCT) is safe and effective for pediatric acute leukemia (AL). This treatment improves survival outcomes and reduces post-transplant relapse rates.
Area of Science:
- Hematology
- Pediatric Oncology
- Immunotherapy
Background:
- Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative option for pediatric acute leukemia (AL).
- Relapse remains a significant challenge post-HSCT, impacting long-term survival.
- Donor lymphocyte infusion (DLI) can potentially mitigate relapse risk.
Purpose of the Study:
- To assess the feasibility and safety of prophylactic donor lymphocyte infusion (DLI) in pediatric patients with acute leukemia (AL) undergoing allogeneic HSCT.
- To evaluate the impact of prophylactic DLI on survival outcomes, including overall survival (OS) and event-free survival (EFS).
- To identify factors associated with prognosis following prophylactic DLI.
Main Methods:
- Retrospective analysis of 101 pediatric patients with AL who received prophylactic DLI post-allogeneic HSCT.
- Data collected on patient demographics, leukemia type, HSCT details, DLI timing and dose, and adverse events.
- Evaluation of graft-versus-host disease (GVHD), OS, and EFS rates.
Main Results:
- Prophylactic DLI was administered at a median of 306 days post-HSCT with a median cumulative dose of 5.00 × 10⁷/kg.
- Graft-versus-host disease (GVHD) occurred in 46.53% of patients, with most cases being mild.
- Five-year OS and EFS rates were 88.74% and 79.66%, respectively.
- Cumulative DLI dose > 4.75 × 10⁷/kg was linked to a favorable prognosis (AUC 0.67, P=0.03).
Conclusions:
- Prophylactic DLI is a feasible and safe strategy for pediatric AL patients post-allogeneic HSCT.
- This approach demonstrates potential in reducing post-transplant relapse and enhancing long-term survival.
- Careful DLI dosing may be crucial for optimizing outcomes in this patient population.
Purpose:
To evaluate the feasibility and safety of prophylactic donor lymphocyte infusion (DLI) following allogeneic hematopoietic stem cell transplantation (HSCT) to improve survival outcomes in pediatric patients with acute leukemia (AL).
Methods:
Children with AL who received prophylactic DLI transfusion after allogeneic HSCT between October 2015 and October 2024 were retrospectively analyzed.
Results:
In total, 101 pediatric patients with AL were enrolled in this study, comprising 42 acute lymphoblastic leukemia, 54 acute myeloid leukemia, and five mixed-phenotype acute leukemia cases. The median age at transplantation was 7.52 ± 3.98 years. The median time from HSCT to first DLI was 306.26 days (range 51.00-1016.00). Patients received a median cumulative dose of 5.00 × 10⁷/kg (0.50-36.20). Post-DLI GVHD occurred in 46.53% of cases. Most events were mild; severe GVHD occurred in only five cases. After prophylactic DLI transfusion, the 5-year overall survival (OS) and event-free survival (EFS) rates were 88.74% ± 3.70% and 79.66% ± 4.92%, respectively. The difference of the OS and EFS in patients with GVHD and without GVHD after prophylactic DLI transfusion were not statistically significant (χ2 = 0.39, P = 0.53 and χ2 = 0.98, P = 0.32). Cumulative DLI dose > 4.75 × 10⁷/kg was associated with favorable prognosis (Area under the curve 0.67, 95% confidence interval 0.50-0.83, P = 0.03).
Conclusion:
Prophylactic DLI transfusion following allogeneic HSCT remains a safe and effective treatment for pediatric patients with AL and can reduce post-transplant relapse and improve long-term survival.
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