Efficacy of immune suppression tapering in treating relapse after reduced intensity allogeneic stem cell transplantation

Natasha Kekre, Haesook T. Kim, Gita Thanarajasingam, Philippe Armand, Joseph H. Antin, Corey Cutler, Sarah Nikiforow, Vincent T. Ho, John Koreth, Edwin P. Alyea, Robert J. Soiffer

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Abstract

For patients who relapse after allogeneic hematopoietic stem cell transplantation while still on immune suppression, there is anecdotal evidence that tapering the immune suppression may result in graft-versus-tumor activity. We reviewed the medical records of all patients with documented histological or radiographic disease recurrence within 1 year of stem cell transplantation while on immune suppression at our institution. The median time to relapse was 110 days (range, 18-311) after transplant. Among 123 patients with relapse treated with immune suppression tapering without chemotherapy, radiation, or donor lymphocyte infusion, 34 responded (33/101 reduced intensity conditioning transplant and 1/22 myeloablative conditioning transplant, 32.7% and 4.5% respectively; P=0.007). The median time to response after initiation of immune suppression tapering was 82 days (range, 16-189). Thirty-three patients (97.1%) had development or progression of acute or chronic graft-versus-host disease as a consequence of immune suppression tapering, at a median time of 39 days (range, 16-98). Six patients subsequently relapsed late after initial response to immune suppression tapering at a median time of 2 years (range, 0.9-3.8). The median overall survival from immune suppression tapering for responders was 5.1 years (range, 1.9-not estimable). When clinically feasible, immune suppression tapering alone in patients who relapse early after reduced intensity conditioning allogeneic stem cell transplantation can produce durable remissions, but is almost always associated with graft-versus-host disease.

Original languageEnglish (US)
Pages (from-to)1222-1227
Number of pages6
JournalHaematologica
Volume100
Issue number9
DOIs
StatePublished - Jan 1 2015

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Stem Cell Transplantation
Recurrence
Transplants
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Medical Records
Tissue Donors
Lymphocytes
Radiation
Drug Therapy
Survival
Neoplasms

ASJC Scopus subject areas

  • Hematology

Cite this

Efficacy of immune suppression tapering in treating relapse after reduced intensity allogeneic stem cell transplantation. / Kekre, Natasha; Kim, Haesook T.; Thanarajasingam, Gita; Armand, Philippe; Antin, Joseph H.; Cutler, Corey; Nikiforow, Sarah; Ho, Vincent T.; Koreth, John; Alyea, Edwin P.; Soiffer, Robert J.

In: Haematologica, Vol. 100, No. 9, 01.01.2015, p. 1222-1227.

Research output: Contribution to journalArticle

Kekre, N, Kim, HT, Thanarajasingam, G, Armand, P, Antin, JH, Cutler, C, Nikiforow, S, Ho, VT, Koreth, J, Alyea, EP & Soiffer, RJ 2015, 'Efficacy of immune suppression tapering in treating relapse after reduced intensity allogeneic stem cell transplantation', Haematologica, vol. 100, no. 9, pp. 1222-1227. https://doi.org/10.3324/haematol.2015.129650
Kekre, Natasha ; Kim, Haesook T. ; Thanarajasingam, Gita ; Armand, Philippe ; Antin, Joseph H. ; Cutler, Corey ; Nikiforow, Sarah ; Ho, Vincent T. ; Koreth, John ; Alyea, Edwin P. ; Soiffer, Robert J. / Efficacy of immune suppression tapering in treating relapse after reduced intensity allogeneic stem cell transplantation. In: Haematologica. 2015 ; Vol. 100, No. 9. pp. 1222-1227.
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