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Clearance of hematological malignancies by allogeneic cytokine-induced killer cell or donor lymphocyte infusions
Merker, M., Salzmann-Manrique, E., Katzki, V., Huenecke, S., Bremm, M., Bakhtiar, S., Willasch, A., Jarisch, A., Soerensen, J., Schulz, A., et al
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2019
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Abstract
Well-established donor lymphocyte infusion (DLI) and novel cytokine-induced killer (CIK) cell therapy for the treatment of relapsing hematological malignancies after allogeneic hematopoietic stem cell transplantation (HSCT) were compared with respect to their feasibility, safety and efficacy. Altogether, a total of 221 infusions were given to 91 patients (DLI, n=55; CIK, n=36). T cell recovery was significantly improved after CIK cell therapy (P<0.0001). Although patients with CIK cell treatment showed a significantly worse prognosis at the time of HSCT (risk score, 1.7 vs 2.1, P<0.0001), DLI and CIK cell therapy induced complete remission (CR) in 29% and 53% patients, respectively, while relapse occurred in 71% and 47%. In both groups, all patients with overt hematological relapse at the time of immunotherapy (DLI, n=11; CIK, n=8) succumbed to their disease, while 36% and 68% patients with DLI or CIK cell therapy applied due to molecular relapse or active disease at the time of transplantation achieved CR. The six-month overall survival rate in the latter patients was 57% and 77%, respectively, with a median follow-up of 27.9 months (range, 0.9-149.2). The six-month cumulative incidence of relapse was 55% and 22% in patients with DLI and CIK cell therapy, respectively (P=0.012). 35% DLI-patients and 25% CIK-patients developed acute graft versus host disease. No transfusion-related deaths were observed. These data, while underscoring the therapeutic value of conventional DLI, suggest the improved safety and to a certain extent efficacy of CIK cell therapy for patients at high risk of post-transplant relapse of various hematological malignancies.
PICO Summary
Population
Patients with haematological malignancies who received allogeneic transplantation (n=91)
Intervention
Cytokine-induced killer cell therapy (n=36)
Comparison
Donor lymphocyte infusions (n=55)
Outcome
T cell recovery was significantly improved after CIK cell therapy. Although patients with CIK cell treatment showed a significantly worse prognosis at the time of HSCT, CIK cell therapy induced complete remission in 53% of patients, compared with 29% of DLI patients, while relapse occurred in 47% and 71% respectively. In both groups, all patients with overt hematological relapse at the time of immunotherapy succumbed to their disease, while 68% of CIK patients and 36% of DLI patients and with molecular relapse or active disease at the time of transplantation achieved CR. The six-month cumulative incidence of relapse was 22% in CIK cell therapy patients and 55% in DLI patients. 25% CIK-patients and 35% DLI-patients developed acute graft versus host disease.