title: A comparison of long-term outcomes of donor lymphocyte infusions and tyrosine kinase inhibitors in patients with relapsed CML after allogeneic hematopoietic cell transplantation.
abstract: 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.
  
  
  METHODS
  A total of 46 patients were treated with either DLI (n = 28) or TKIs (n = 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 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 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 = .01), shorter failure-free survival (FFS) (HR, 21.15; 95% CI, 1.8-251; P = .02), higher cumulative incidence of failure (CIF) (HR, 19.5; 95% CI, 1.6-236.5; P = .02), and increased incidence of treatment-induced graft vs. host disease (GVHD) (68% vs. 6%; P = .001).
  
  
  CONCLUSIONS
  TKIs appear better than DLI in chronic-phase relapses after myeloablative non-T-cell-depleted HCT. Outcomes were poor in advanced-phase relapses irrespective of treatment modality.
authors.affiliation: Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada. Electronic address: mohamed.shanavas@uhn.ca.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Shanavas
authors.affiliation: Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Hans A
authors.initials: HA
authors.lastname: Messner
authors.affiliation: Department of Pathology, University Health Network, Toronto, Ontario, Canada.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Kamel-Reid
authors.affiliation: Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario Canada.
authors.forename: Eshetu G
authors.initials: EG
authors.lastname: Atenafu
authors.affiliation: Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Kuruvilla
authors.affiliation: Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Dennis Dong Hwan
authors.initials: DD
authors.lastname: Kim
authors.affiliation: Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Jieun
authors.initials: J
authors.lastname: Uhm
authors.affiliation: Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Lambie
authors.affiliation: Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Ellis
authors.affiliation: Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lipton
mesh_terms: D000328:Adult; D005260:Female; D042381:Granulocyte Precursor Cells / Q000187:drug effects / Q000378:metabolism; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000601:surgery / Q000628:therapy*; D017710:Lymphocyte Transfusion / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000601:surgery / Q000628:therapy*; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors*; D013601:T-Lymphocytes / Q000187:drug effects / Q000378:metabolism; D019172:Transplantation Conditioning / Q000379:methods
chemical_list: D047428:Protein Kinase Inhibitors; D011505:Protein-Tyrosine Kinases
keywords: Chronic myeloid leukemia; Donor lymphocyte infusion; Hematopoietic cell transplantation; Relapse; Tyrosine kinase inhibitor