Younger patients with relapsed or refractory myelodysplastic syndromes (MDS) may have improved overall survival (OS) after receiving donor lymphocyte infusion (DLI) and previously undergoing hematopoietic stem cell transplant.
A recent study published in the journal Cytotherapy showed that patients who were younger, had a cytogenic or molecular relapse and experienced a late relapse may have improved OS after DLI.
Researchers from the study found that although this infusion led to graft-versus-host-disease (GVHD), its effect on the prognosis of the disease was shown to be minimal. Of note, the researchers stated that DLI should be a considered treatment option for patients with relapsed or refractory MDS, post-stem cell treatment.
The study included 107 patients with relapsed or refractory MDS, who previously received DLI and had undergone their first stem cell transplant between 2002 and 2022.
“Allogeneic hematopoietic stem cell transplantation is the curative treatment for MDS and has significantly improved patient outcomes,” the researchers wrote. “Despite improvements in nonrelapse mortality rates after hematopoietic stem cell transplantation, relapse rates remain high, and there is no established treatment strategy for patients who relapse post-transplantation.
“Treatment options are limited, with donor lymphocyte infusion being one of the few available treatment options.”
Overall Survival Outcomes After DLI in Relapsed or Refractory MDS
At one year, the OS in the patient population was 30%, according to the study. The researchers identified four factors associated with poor prognosis. These included being age 58 or older, having a complex karyotype, hematologic relapse or an early relapse. However, the researchers established that patients who received Vidaza (azacitidine) along with DLI demonstrated improved prognosis.
WATCH: ‘Tempo’ of MDS Helps With Timing for Stem Cell Transplants
Patients specifically aged 58 or older who experienced disease cytogenetic relapse less than 110 days after stem cell transplant demonstrated an OS of 43.6% at one year. This OS was compared with 9.4% in patients who experienced hematologic relapse.
“DLI in patients with MDS with relapse after HSCT showed a one-year OS of 30%, consistent with previous findings,” the researchers noted in the study. “The prognosis for post-hematopoietic stem cell transplantation relapse remains poor, with a second [stem cell transplantation] representing the sole curative treatment.”
Safety and GVHD After DLI in Relapsed or Refractory MDS
Regarding safety, GVHD was the main side effect the researchers focused on in this study. Of note, GVHD is considered a “significant side effect of DLI, although its development has been associated with reduced relapse rates,” the researchers stated in the study.
GVHD concerns were raised during the study; nevertheless, the researchers emphasized that there are now existing drugs to help treat GVHD.
READ MORE: GVHD Prophylaxis Using PTCY Remains Valid Treatment Option in MDS
“The frequency of GVHD after DLI, the response rate to treatment and the impact of GVHD on OS need further investigation,” the researchers wrote.
In the study, 87 patients had died after DLI treatment, according to the study. Researchers found that the most frequent causes of death were because of relapse or progression of MDS in 56 patients and infectious complications in 22 patients.
References
“Outcome of donor lymphocyte infusion after allogeneic hematopoietic stem cell transplantation in relapsed myelodysplastic syndrome” by Atsushi Marumo, et al., Cytotherapy.
For more news on cancer updates, research, and education, don’t forget to subscribe to CURE®’s newsletters here.
