Platelet Refractoriness Is Associated with Delayed Platelet Engraftment and Increased Graft Versus Host Disease Following Peripheral Blood or Bone Marrow Derived Stem Cell Transplantation

M.J. Gandhi, B.A. Schneider, S. Jenkins, W.J. Hogan, M.R. Litzow, D.A. Gastineau, J.R. Stubbs, M.S. Patnaik
2012 Biology of Blood and Marrow Transplantation  
Patients with post-allogeneic HSCT disease relapse can be treated with salvage chemotherapy but are also candidates for immune suppression withdrawal and/or donor lymphocyte infusion (DLI). A total of 237 adult patients experienced relapse of disease post-allogeneic transplant at our institution between 1995 and 2010. A retrospective institutional analysis was performed on the 52 patients who received DLI in that timeframe. The DLI product infusion doses ranged from 0.07 to 4.0 x 10 8 CD3+
more » ... . CML patients had the most favorable DLI response rates with 78% (n 5 7) in remission at 3 years. Patients with relapsed AML/ MDS and lymphoid malignancies fared worse with 36% and 21% OS at 3 years respectively. OS was superior in patients in CR prior to DLI (45%) compared to those with active disease (5%) and for patients under the age of 50 (32% vs 21%). Three year OS was observed of 5% for patients who relapsed prior to day +100, 29% for relapse between day +100 and 1 year, and 59% for relapse after 1 year. Patients who developed GvHD prior to relapse had a 3 year OS of 35% vs 9% in patients without GvHD. Patients with post-DLI GvHD had a 39% OS vs 11% for patients without GvHD after DLI. No difference in post-DLI survival was noted with regards to pre-transplant disease status, cell dose or transplant conditioning. CML patients respond well to DLI however in the TKI era, transplants for these patients are reserved for patients with TKI-resistant disease. In other patients, immune suppression withdrawal and DLI have limited efficacy for those who do not achieve CR post-relapse or who relapse within 3 months of transplant. These patients are in need of alternative treatment strategies.
doi:10.1016/j.bbmt.2011.12.387 fatcat:bunvu26jsvfm7c3kgdy3jhjbiu