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学科主题: 临床医学
题名:
Immunosuppression for 6-8 weeks after modified donor lymphocyte infusion reduced acute graft-versus-host disease without influencing graft-versus-leukemia effect in haploidentical transplant
作者: Yan Chenhua; Xu Lanping; Liu Daihong; Chen Huan; Wang Yu; Liu Kaiyan; Huang Xiaojun
关键词: allogeneic hematopoietic stem cell transplantation ; haploidentical ; graft-versus-host disease ; modified donor lymphocyte infusion ; graft-versus-leukemia effects
刊名: CHINESE MEDICAL JOURNAL
发表日期: 2014-10-20
DOI: 10.3760/cma.j.issn.0366-6999.20141481
卷: 127, 期:20, 页:3602-3609
收录类别: SCI
文章类型: Article
WOS标题词: Science & Technology
类目[WOS]: Medicine, General & Internal
研究领域[WOS]: General & Internal Medicine
关键词[WOS]: STEM-CELL TRANSPLANTATION ; BONE-MARROW-TRANSPLANTATION ; ACUTE MYELOID-LEUKEMIA ; HEMATOLOGICAL MALIGNANCIES ; LEUKOCYTE INFUSIONS ; RISK-FACTORS ; RELAPSE
英文摘要:

Background In haploidentical hematopoietic stem cell transplantation (HSCT), the duration of graft-versus-host disease (GVHD) prophylaxis after modified donor lymphocyte infusion (DLI) was the only risk factor of DLI-associated grades 3-4 acute GVHD. However, the successful application of modified DLI depended not only on the reduction of severe GVHD, but also on the preservation of graft-versus-leukemia (GVL) effect. Therefore, this study was performed to compare the impact of prophylaxis for 6-8 weeks and prophylaxis for <6 weeks on GVL effect after modified DLI in haploidentical HSCT.

Methods A total of 103 consecutive patients developing hematological relapse or minimal residual disease (MRD)-positive status after haploidentical HSCT and receiving modified DLI were investigated retrospectively. Fifty-two patients received prophylaxis for 6-8 weeks after modified DLI; the remaining 51 patients received prophylaxis for <6 weeks.

Results First, compared with prophylaxis for <6 weeks, prophylaxis for 6-8 weeks reduced incidence of relapse in total patients (26.6% vs. 69.0%, P<0.001). Besides, prophylaxis for 6-8 weeks also reduced incidence of relapse in 54 patients developing hematological relapse post-transplant (P=0.018) and in 49 patients developing MRD-positive status post-transplant (P<0.001). Second, prophylaxis for 6-8 weeks reduced incidence of acute GVHD (P<0.05), reduced the therapeutic application of immunosuppressive agents (P=0.019), but increased the incidence of chronic GVHD (P<0.05). Third, prophylaxis for 6-8 weeks improved overall survival and disease-free survival in total patients, as well as in patients developing hematological relapse post-transplant and in patients developing MRD-positive status post-transplant (P<0.05).

Conclusions In haploidentical HSCT, prophylaxis for 6-8 weeks after modified DLI does not reduce GVL effect, but reduces the incidence of DLI,associated acute GVHD compared with prophylaxis for <6 weeks. This strategy will probably improve the safety and efficacy of modified DLI further.

语种: 英语
WOS记录号: WOS:000344724100016
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/51666
Appears in Collections:北京大学第二临床医学院_血液科_期刊论文

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作者单位: Peking Univ, Beijing Key Lab Hematopoiet Stem Cell Transplanta, Inst Hematol, Dept Hematol,Peoples Hosp, Beijing 100044, Peoples R China

Recommended Citation:
Yan Chenhua,Xu Lanping,Liu Daihong,et al. Immunosuppression for 6-8 weeks after modified donor lymphocyte infusion reduced acute graft-versus-host disease without influencing graft-versus-leukemia effect in haploidentical transplant[J]. CHINESE MEDICAL JOURNAL,2014,127(20):3602-3609.
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