- 作者：Mohamed Shanavas ; Hans A. Messner ; Suzanne Kamel-Reid ; Eshetu G. Atenafu ; Vikas Gupta ; John Kuruvilla ; Dennis (Dong Hwan) Kim ; Jieun Uhm ; Anna Lambie ; Laura Ellis ; Jeffrey H. Lipton
- 关键词：Chronic myeloid leukemia ; Donor lymphocyte infusion ; Hematopoietic cell transplantation ; Relapse ; Tyrosine kinase inhibitor
- 刊名：Clinical Lymphoma Myeloma and Leukemia
- 出版年：February, 2014
- 年：2014
- 卷：14
- 期：1
- 页码：87-92
- 全文大小：376 K
Background
Donor lymphocyte infusion (DLI) and tyrosine kinase inhibitors (TKIs) are the 2 standard treatment options in chronic myeloid leukemia (CML) that relapses after hematopoietic cell transplantation (HCT), but reports comparing long-term outcomes of these modalities are rare.Patients and Methods
A total of 46 patients were treated with either DLI (n聽= 28) or TKIs (n聽= 18) during a first relapse of CML after HCT between 1993 and 2012. The stage of relapse was the chronic phase in 37 patients and the advanced phase in 9 patients. All patients had myeloablative conditioning without T-cell depletion during HCT. The median interval between HCT and treatment for聽relapse was 34 (range, 2-197) months.
Results
At a median follow-up of 146 and 70 months, respectively, 32% of the DLI group and 33% of the TKI group had died. Six (21%) patients initially treated with DLI received TKIs during a聽second relapse. In multivariable analyses, DLI was associated with inferior overall survival (OS) (hazard ratio [HR], 37.4; 95% confidence interval [CI], 2.2-625.4; P聽= .01), shorter failure-free survival (FFS) (HR, 21.15; 95% CI, 1.8-251; P聽= .02), higher cumulative incidence of failure (CIF) (HR, 19.5; 95% CI, 1.6-236.5; P聽= .02), and increased incidence of treatment-induced graft vs. host disease (GVHD) (68% vs. 6%; P聽= .001).
Conclusion
TKIs appear better than DLI in聽chronic-phase relapses after myeloablative non-T-cell-depleted HCT. Outcomes were poor in advanced-phase relapses irrespective of treatment modality.