title: Minimal residual disease- and graft-vs.-host disease-guided multiple consolidation chemotherapy and donor lymphocyte infusion prevent second acute leukemia relapse after allotransplant.
abstract: Persons with acute leukemia relapsing after allotransplant and who respond to anti-leukemia interventions are at high risk of a second relapse. We studied the impact of minimal residual disease (MRD)- and graft-vs.-host disease (GvHD)-guided multiple consolidation chemotherapy and donor lymphocyte infusions (DLIs) to prevent second relapse in patients with acute leukemia relapsing post-transplant and who achieved complete remission after induction chemotherapy and DLI.
  
  
  
  Forty-seven subjects with acute leukemia relapsing after an allotransplant and who achieved complete remission after post-relapse induction chemotherapy and DLI were eligible. The use of consolidation chemotherapy and DLI was guided by the results of MRD testing and whether or not DLI caused acute and/or chronic GvHD. Outcomes were compared with those of 34 similar historical controls who did not receive consolidation chemotherapy and DLIs after induction chemotherapy and DLI.
  
  
  
  One-year cumulative incidence of relapse (CIR; 22 % 95 % confidence interval (10, 35 %) vs. 56 % (39, 73 %); P < 0.0001), leukemia-free survival (LFS; 71 % (57, 84 %) vs. 35 % (19, 51 %); P < 0.0001), and survival (78 % (66, 90 %) vs. 44 % (27, 61 %); P < 0.0001) was significantly better in subjects than controls. In multivariate analyses, no chronic GvHD after therapy (hazard ratio (HR) = 3.56 (1.09, 11.58); P = 0.035) and a positive MRD test after therapy (HR = 21.04 (4.44, 94.87); P < 0.0001) were associated with an increased CIR.
  
  
  
  These data suggest MRD- and GvHD-guided multiple consolidation chemotherapy and DLIs reduce CIR and increase LFS and survival compared with controls in persons relapsing after allotransplant for acute leukemia.
  
  
  
  ChiCTR-ONC-12002912 . Donor lymphocyte infusion for the treatment of leukemia relapse following allogeneic hematopoeitic stem cell transplant.
authors.affiliation: Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Xi Zhimen South Street No. 11, Beijing, 100044, China.|Collaborative Innovation Center of Hematology, Xi Zhimen South Street No. 11, Beijing, 100044, China.
authors.forename: Chen-Hua
authors.initials: CH
authors.lastname: Yan
authors.affiliation: Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Xi Zhimen South Street No. 11, Beijing, 100044, China.|Collaborative Innovation Center of Hematology, Xi Zhimen South Street No. 11, Beijing, 100044, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Xi Zhimen South Street No. 11, Beijing, 100044, China.
authors.forename: Jing-Zhi
authors.initials: JZ
authors.lastname: Wang
authors.affiliation: Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Xi Zhimen South Street No. 11, Beijing, 100044, China.
authors.forename: Yu-Hong
authors.initials: YH
authors.lastname: Chen
authors.affiliation: Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Xi Zhimen South Street No. 11, Beijing, 100044, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Xi Zhimen South Street No. 11, Beijing, 100044, China.
authors.forename: Feng-Rong
authors.initials: FR
authors.lastname: Wang
authors.affiliation: Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Xi Zhimen South Street No. 11, Beijing, 100044, China.
authors.forename: Yu-Qian
authors.initials: YQ
authors.lastname: Sun
authors.affiliation: Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Xi Zhimen South Street No. 11, Beijing, 100044, China.
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Mo
authors.affiliation: Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Xi Zhimen South Street No. 11, Beijing, 100044, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Han
authors.affiliation: Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Xi Zhimen South Street No. 11, Beijing, 100044, China.
authors.forename: Huan
authors.initials: H
authors.lastname: Chen
authors.affiliation: Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Xi Zhimen South Street No. 11, Beijing, 100044, China.|Collaborative Innovation Center of Hematology, Xi Zhimen South Street No. 11, Beijing, 100044, China.
authors.forename: Xiao-Hui
authors.initials: XH
authors.lastname: Zhang
authors.affiliation: Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Xi Zhimen South Street No. 11, Beijing, 100044, China.
authors.forename: Lan-Ping
authors.initials: LP
authors.lastname: Xu
authors.affiliation: Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Xi Zhimen South Street No. 11, Beijing, 100044, China.|Collaborative Innovation Center of Hematology, Xi Zhimen South Street No. 11, Beijing, 100044, China.
authors.forename: Kai-Yan
authors.initials: KY
authors.lastname: Liu
authors.affiliation: Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Xi Zhimen South Street No. 11, Beijing, 100044, China. huangxiaojun@bjmu.edu.cn.|Collaborative Innovation Center of Hematology, Xi Zhimen South Street No. 11, Beijing, 100044, China. huangxiaojun@bjmu.edu.cn.
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Huang
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D060830:Consolidation Chemotherapy / Q000379:methods*; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology*; D006801:Humans; D007938:Leukemia / Q000150:complications / Q000401:mortality / Q000628:therapy*; D017710:Lymphocyte Transfusion / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000175:diagnosis*; D016609:Neoplasms, Second Primary; D012008:Recurrence; D055502:Secondary Prevention; D016019:Survival Analysis; D014184:Transplantation, Homologous; D055815:Young Adult
keywords: Acute leukemia; Allogeneic hematopoietic stem cell transplant; Donor lymphocyte infusions; Graft-vs.-host disease; Leukemia relapse; Minimal residual disease