PMID- 36274263 OWN - NLM STAT- MEDLINE DCOM- 20221220 LR - 20230123 IS - 2523-3548 (Electronic) IS - 2523-3548 (Linking) VI - 42 IP - 12 DP - 2022 Dec TI - Optimized therapeutic strategy for patients with refractory or relapsed acute myeloid leukemia: long-term clinical outcomes and health-related quality of life assessment. PG - 1387-1402 LID - 10.1002/cac2.12376 [doi] AB - BACKGROUND: Patients with refractory or relapsed acute myeloid leukemia (AML) have poor survival, necessitating the exploration of optimized therapeutic strategy. Here, we aimed to investigate clinical outcomes and health-related quality of life (HR-QoL) after total therapy, which included allogeneic hematopoietic stem cell transplantation (allo-HSCT), and prophylactic donor lymphocyte infusion (DLI) in the early phase after transplantation, followed by multiple measurable residual disease (MRD) and graft-versus-host disease (GvHD)-guided DLIs. METHODS: Consecutive patients who had refractory or relapsed AML and had received non-T-cell-depleted allo-HSCT at Peking University Institute of Hematology were included in the study. If the patients achieved complete remission at 30 days after transplantation and had no evidence of relapse, severe infection, organ failure, and active GvHD at the time of planned DLI, prophylactic DLI was administered at 30 days after transplantation for human leukocyte antigen (HLA)-matched related HSCT or at 45-60 days after transplantation for haploidentical or unrelated HSCT. Subsequently, multiple DLIs were administered based on MRD results and whether they developed GvHD after transplantation. RESULTS: A total of 105 patients were eligible. Eighty-seven patients received prophylactic DLI (group B), while 18 did not receive prophylactic DLI (group A). Among 105 patients, the cumulative incidence of grade 2-4 acute GvHD and chronic GvHD was 40.6% (95% confidence interval [CI] = 30.6%-50.6%) and 73.3% (95% CI = 67.4%-79.2%), respectively. The cumulative incidence of relapse (CIR), transplant-related mortality (TRM), and leukemia-free survival (LFS) at 5 years after transplantation were 31.5% (95% CI = 21.9%-41.1%), 22.1% (95% CI = 11.3%-32.9%), and 46.4% (95% CI = 36.8%-56.0%), respectively. In group B, the CIR, TRM, and LFS at 5 years after transplantation were 27.6% (95% CI = 17.6%-37.6%), 21.6% (95% CI = 11.2%-32.0%), and 50.8% (95% CI = 40.0%-61.6%), respectively. At the end of follow-up, 48 patients survived, and more than 90% of survivors had satisfactory recoveries of HR-QoL. CONCLUSIONS: Our study indicated that total therapy is not only associated with decreased CIR, comparable TRM, and better long-term LFS, but also with satisfactory HR-QoL for refractory or relapsed AML, compared with those of standard of care therapy reported previously. Therefore, total therapy may be an optimized therapeutic strategy for refractory or relapsed AML. CI - (c) 2022 The Authors. Cancer Communications published by John Wiley & Sons Australia, Ltd. on behalf of Sun Yat-sen University Cancer Center. FAU - Yan, Chen-Hua AU - Yan CH AD - Peking University Peoples Hospital, Peking University Institute of Hematology, Beijing, 100044, P. R. China. AD - National Clinical Research Center for Hematologic Disease, Beijing, 100044, P. R. China. AD - Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, P. R. China. FAU - Wang, Yu AU - Wang Y AUID- ORCID: 0000-0003-1253-7465 AD - Peking University Peoples Hospital, Peking University Institute of Hematology, Beijing, 100044, P. R. China. AD - National Clinical Research Center for Hematologic Disease, Beijing, 100044, P. R. China. AD - Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, P. R. China. FAU - Sun, Yu-Qian AU - Sun YQ AD - Peking University Peoples Hospital, Peking University Institute of Hematology, Beijing, 100044, P. R. China. AD - National Clinical Research Center for Hematologic Disease, Beijing, 100044, P. R. China. AD - Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, P. R. China. FAU - Cheng, Yi-Fei AU - Cheng YF AD - Peking University Peoples Hospital, Peking University Institute of Hematology, Beijing, 100044, P. R. China. AD - National Clinical Research Center for Hematologic Disease, Beijing, 100044, P. R. China. AD - Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, P. R. China. FAU - Mo, Xiao-Dong AU - Mo XD AUID- ORCID: 0000-0002-9881-7945 AD - Peking University Peoples Hospital, Peking University Institute of Hematology, Beijing, 100044, P. R. China. AD - National Clinical Research Center for Hematologic Disease, Beijing, 100044, P. R. China. AD - Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, P. R. China. FAU - Wang, Feng-Rong AU - Wang FR AD - Peking University Peoples Hospital, Peking University Institute of Hematology, Beijing, 100044, P. R. China. AD - National Clinical Research Center for Hematologic Disease, Beijing, 100044, P. R. China. AD - Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, P. R. China. FAU - Chen, Yu-Hong AU - Chen YH AD - Peking University Peoples Hospital, Peking University Institute of Hematology, Beijing, 100044, P. R. China. AD - National Clinical Research Center for Hematologic Disease, Beijing, 100044, P. R. China. AD - Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, P. R. China. FAU - Zhang, Yuan-Yuan AU - Zhang YY AD - Peking University Peoples Hospital, Peking University Institute of Hematology, Beijing, 100044, P. R. China. AD - National Clinical Research Center for Hematologic Disease, Beijing, 100044, P. R. China. AD - Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, P. R. China. FAU - Han, Ting-Ting AU - Han TT AD - Peking University Peoples Hospital, Peking University Institute of Hematology, Beijing, 100044, P. R. China. AD - National Clinical Research Center for Hematologic Disease, Beijing, 100044, P. R. China. AD - Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, P. R. China. FAU - Chen, Huan AU - Chen H AD - Peking University Peoples Hospital, Peking University Institute of Hematology, Beijing, 100044, P. R. China. AD - National Clinical Research Center for Hematologic Disease, Beijing, 100044, P. R. China. AD - Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, P. R. China. FAU - Xu, Lan-Ping AU - Xu LP AD - Peking University Peoples Hospital, Peking University Institute of Hematology, Beijing, 100044, P. R. China. AD - National Clinical Research Center for Hematologic Disease, Beijing, 100044, P. R. China. AD - Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, P. R. China. FAU - Zhang, Xiao-Hui AU - Zhang XH AD - Peking University Peoples Hospital, Peking University Institute of Hematology, Beijing, 100044, P. R. China. AD - National Clinical Research Center for Hematologic Disease, Beijing, 100044, P. R. China. AD - Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, P. R. China. FAU - Liu, Kai-Yan AU - Liu KY AD - Peking University Peoples Hospital, Peking University Institute of Hematology, Beijing, 100044, P. R. China. AD - National Clinical Research Center for Hematologic Disease, Beijing, 100044, P. R. China. AD - Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, P. R. China. FAU - Huang, Xiao-Jun AU - Huang XJ AUID- ORCID: 0000-0002-2145-6643 AD - Peking University Peoples Hospital, Peking University Institute of Hematology, Beijing, 100044, P. R. China. AD - National Clinical Research Center for Hematologic Disease, Beijing, 100044, P. R. China. AD - Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, P. R. China. AD - Peking-Tsinghua Center for Life Science, Beijing, 100044, P. R. China. LA - eng SI - ClinicalTrials.gov/NCT01455272 PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20221023 PL - United States TA - Cancer Commun (Lond) JT - Cancer communications (London, England) JID - 101723675 SB - IM MH - Humans MH - Transplantation, Homologous MH - Quality of Life MH - *Graft vs Host Disease/etiology/prevention & control MH - *Leukemia, Myeloid, Acute/therapy MH - Neoplasm, Residual MH - Recurrence PMC - PMC9759766 OTO - NOTNLM OT - acute myeloid leukemia OT - allogeneic hematopoietic stem cell transplantation OT - refractory OT - relapsed OT - total therapy COIS- The authors declare that they have no competing interests. EDAT- 2022/10/25 06:00 MHDA- 2022/12/21 06:00 PMCR- 2022/10/23 CRDT- 2022/10/24 02:52 PHST- 2022/08/24 00:00 [revised] PHST- 2022/01/28 00:00 [received] PHST- 2022/10/13 00:00 [accepted] PHST- 2022/10/25 06:00 [pubmed] PHST- 2022/12/21 06:00 [medline] PHST- 2022/10/24 02:52 [entrez] PHST- 2022/10/23 00:00 [pmc-release] AID - CAC212376 [pii] AID - 10.1002/cac2.12376 [doi] PST - ppublish SO - Cancer Commun (Lond). 2022 Dec;42(12):1387-1402. doi: 10.1002/cac2.12376. Epub 2022 Oct 23.