Treatment for relapse of chronic myeloid leukemia (CML) following hematopoietic cell transplantation (HCT) includes tyrosine kinase inhibitors (TKI) with or without donor lymphocyte infusions (DLI), however the most effective treatment strategy is unknown. This study was performed through the Center for International Blood and Marrow Transplant Research (CIBMTR) database. We retrospectively reviewed all patients reported to the CIBMTR registry from 2002-2014 who underwent HCT for CML and were alive 30 days post relapse. A total of 215 HCT recipients relapsed and were analyzed in the following groups 1) TKI alone n=128, 2) TKI with DLI n=48, and 3) DLI without TKI n=39. In multivariate analysis, disease status prior to HCT had a significant effect on overall survival (OS). Patients that received a DLI alone compared to a TKI with DLI had inferior survival HR 2.28 (95% CI 1.23-4.24; p = 0.009). Those who received TKI alone had similar survival compared to those who received TKI with DLI (p=0.81). These data supports that despite use of TKI pre-transplantation, TKI salvage therapy continues to provide significant survival following relapse in patients with CML following HCT. These data does not suggest that adding a DLI to TKI adds an improvement in OS.

中文翻译：

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供体淋巴细胞输注 (DLI) 在酪氨酸激酶抑制剂 (TKI) 时代慢性粒细胞白血病 (CML) 造血细胞移植 (HCT) 后复发中的作用。

造血细胞移植 (HCT) 后慢性粒细胞白血病 (CML) 复发的治疗包括酪氨酸激酶抑制剂 (TKI)，有或没有供体淋巴细胞输注 (DLI)，但最有效的治疗策略尚不清楚。这项研究是通过国际血液和骨髓移植研究中心 (CIBMTR) 数据库进行的。我们回顾性审查了 2002 年至 2014 年报告给 CIBMTR 注册中心的所有患者，这些患者因 CML 接受了 HCT，并且在复发后 30 天仍然存活。总共 215 名 HCT 接受者复发并在以下组中进行了分析：1) 单独的 TKI n=128，2) 有 DLI 的 TKI n=48，和 3) 没有 TKI 的 DLI n=39。在多变量分析中，HCT 之前的疾病状态对总生存期 (OS) 有显着影响。与采用 DLI 的 TKI 相比，单独接受 DLI 的患者生存率较差，HR 2.28（95% CI 1.23-4.24；p = 0.009）。与接受 TKI 和 DLI 的患者相比，单独接受 TKI 的患者生存率相似（p=0.81）。这些数据支持，尽管在移植前使用了 TKI，但 TKI 挽救治疗继续为 HCT 后 CML 患者提供复发后显着的存活率。这些数据并不表明将 DLI 添加到 TKI 会增加操作系统的改进。