title: Donor lymphocyte infusion in the treatment of first hematological relapse after allogeneic stem-cell transplantation in adults with acute myeloid leukemia: a retrospective risk factors analysis and comparison with other strategies by the EBMT Acute Leukemia Working Party.
abstract: OBJECTIVE
  To evaluate the role of donor lymphocyte infusion (DLI) in the treatment of relapsed acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (HSCT).
  
  
  METHODS
  We retrospectively analyzed the data of 399 patients with AML in first hematological relapse after HSCT whose treatment did (n = 171) or did not (n = 228) include DLI. After correction for imbalances and established risk factors, the two groups were compared with respect to overall survival. Further, a detailed analysis of risk factors for survival among DLI recipients was performed.
  
  
  RESULTS
  Median follow-up was 27 and 40 months, respectively. Estimated survival at 2 years (+/- standard deviation) was 21% +/- 3% for patients receiving DLI and 9% +/- 2% for patients not receiving DLI. After adjustment for differences between the groups, better outcome was associated with age younger than 37 years (P = .008), relapse occurring more than 5 months after HSCT (P < .0001), and use of DLI (P = .04). Among DLI recipients, a lower tumor burden at relapse (< 35% of bone marrow blasts; P = .006), female sex (P = .02), favorable cytogenetics (P = .004), and remission at time of DLI (P < .0001) were predictive for survival in a multivariate analysis. Two-year survival was 56% +/- 10%, if DLI was performed in remission or with favorable karyotype, and 15% +/- 3% if DLI was given in aplasia or with active disease.
  
  
  CONCLUSIONS
  Although further evidence for a graft-versus-leukemia effect by DLI is provided, our results confirm, that the clinical benefit is limited to a minority of patients. Strategies to reduce tumor burden before DLI, as well as alternative treatment options should be investigated in adults with relapsed AML after HSCT.
authors.affiliation: Department of Medicine II, Klinikum Augsburg, Ludwig Maximilians University of Munich, Augsburg, Germany. christoph.schmid@2med.zk.augsburg-med.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmid
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
authors.forename: Martin
authors.initials: M
authors.lastname: Bornhäuser
authors.forename: Jürgen
authors.initials: J
authors.lastname: Finke
authors.forename: Athanasios
authors.initials: A
authors.lastname: Fassas
authors.forename: Liisa
authors.initials: L
authors.lastname: Volin
authors.forename: Günham
authors.initials: G
authors.lastname: Gürman
authors.forename: Johan
authors.initials: J
authors.lastname: Maertens
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordigoni
authors.forename: Ernst
authors.initials: E
authors.lastname: Holler
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ehninger
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Polge
authors.forename: Norbert-Claude
authors.initials: NC
authors.lastname: Gorin
authors.forename: Hans-Jochem
authors.initials: HJ
authors.lastname: Kolb
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D017710:Lymphocyte Transfusion; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome