TY - JOUR
T1 - Identification of patients who may benefit from prophylactic immunotherapy after bone marrow transplantation for acute myeloid leukemia on the basis of lymphocyte recovery early after transplantation
AU - Powles, Ray
AU - Singhal, Seema
AU - Treleaven, Jennifer
AU - Kulkarni, Samar
AU - Horton, Clive
AU - Mehta, Jayesh
N1 - Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 1998/5/1
Y1 - 1998/5/1
N2 - Two hundred and one patients (median age, 29 years) with acute myeloid leukemia (AML) underwent bone marrow transplantation (BMT) from HLA-identical sibling donors after conditioning with melphelan-total-body irradiation (TBI) (57%), cyclophosphamide-TBI (35%), or chemotherapy alone (8%). Graft-versus- host disease (GVHD) prophylaxis included cyclosporine alone (68%), cyclosporine-methotrexate (26%), or T-cell depletion (6%). The probability of relapse was calculated as a function of the absolute lymphocyte count (10s/L) on days 27 to 30 posttransplant (<0.1 v ≤0.1, <0.2 v ≤0.2, and <0.3 v ≤0.3). In each of these 12 comparisons, the probability of relapse was higher for the group with the lower lymphocyte count. Because the difference was most significant (P = .004) for an absolute lymphocyte count of <0.2 on day 29 (3-year relapse probability, 42%) versus ≤ 0.2 (16%), this variable was included in a Cox model to determine factors independently affecting relapse. Multivariate analysis showed that conditioning regimens other than melphalan-TBI, a low lymphocyte count on day 29, FrenchAmerican-British (FAB) subtypes M4-7, and a nucleated cell dose of > 2.42 x 108/kg was associated with a higher risk of relapse. We conclude that slow lymphocyte recovery after allogeneic BMT, to < 0.2 x 109/L 29 days in this analysis, appears to be associated with a higher risk of relapse in patients with AML. This group of patients may benefit from posttransplant immune manipulations such as abbreviated GVHD prophylaxis, or donor cell or cytokine administration to enhance graft-versus-leukemia reactions to reduce relapse.
AB - Two hundred and one patients (median age, 29 years) with acute myeloid leukemia (AML) underwent bone marrow transplantation (BMT) from HLA-identical sibling donors after conditioning with melphelan-total-body irradiation (TBI) (57%), cyclophosphamide-TBI (35%), or chemotherapy alone (8%). Graft-versus- host disease (GVHD) prophylaxis included cyclosporine alone (68%), cyclosporine-methotrexate (26%), or T-cell depletion (6%). The probability of relapse was calculated as a function of the absolute lymphocyte count (10s/L) on days 27 to 30 posttransplant (<0.1 v ≤0.1, <0.2 v ≤0.2, and <0.3 v ≤0.3). In each of these 12 comparisons, the probability of relapse was higher for the group with the lower lymphocyte count. Because the difference was most significant (P = .004) for an absolute lymphocyte count of <0.2 on day 29 (3-year relapse probability, 42%) versus ≤ 0.2 (16%), this variable was included in a Cox model to determine factors independently affecting relapse. Multivariate analysis showed that conditioning regimens other than melphalan-TBI, a low lymphocyte count on day 29, FrenchAmerican-British (FAB) subtypes M4-7, and a nucleated cell dose of > 2.42 x 108/kg was associated with a higher risk of relapse. We conclude that slow lymphocyte recovery after allogeneic BMT, to < 0.2 x 109/L 29 days in this analysis, appears to be associated with a higher risk of relapse in patients with AML. This group of patients may benefit from posttransplant immune manipulations such as abbreviated GVHD prophylaxis, or donor cell or cytokine administration to enhance graft-versus-leukemia reactions to reduce relapse.
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U2 - 10.1182/blood.v91.9.3481.3481_3481_3486
DO - 10.1182/blood.v91.9.3481.3481_3481_3486
M3 - Article
C2 - 9558408
AN - SCOPUS:0032079672
SN - 0006-4971
VL - 91
SP - 3481
EP - 3486
JO - Blood
JF - Blood
IS - 9
ER -