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Treatment of relapsed AML and MDS after allogeneic stem cell transplantation with decitabine and DLI—a retrospective multicenter analysis on behalf of the German Cooperative Transplant Study Group

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Abstract

In contrast to the evidence regarding azacitidine (Aza), there is limited knowledge about the combination of decitabine (DAC) and donor lymphocyte infusions as salvage therapy for relapse after allogeneic stem cell transplantation (allo-SCT) so far. We retrospectively analyzed data of 36 patients with hematological (n = 35) or molecular relapse (n = 1) of acute myeloid leukemia (AML, n = 29) or myelodysplastic syndrome (MDS, n = 7) collected from 6 German transplant centers. Patients were treated with a median of 2 cycles DAC (range, 1 to 11). DAC was the first salvage therapy in 16 patients (44%), whereas 20 patients (56%) had previously received 1 to 5 lines of salvage therapy including 16 of them had been treated with Aza. In 22 patients (61%), a median of 2 DLI per patient (range, 1 to 5) was administered in addition to DAC. As a result, overall response rate was 25% including 6 complete remissions (CR, 17%) and 3 partial remissions (PR, 8%). Three patients within the first-line group achieved CR, while also 3 patients receiving DAC as second-line treatment reached CR including 2 patients with previous Aza failure. Median duration of CR was 10 months (range, 2 to 33) and no patient relapsed so far. The 2-year OS rate was 11% (± 6%) without any difference between first-line and pretreated patients. Incidence of acute and chronic graft-versus-host disease was 19 and 5%. Taken together, DAC exerts clinical efficacy in patients with AML or MDS relapsing after allo-SCT and is able to induce durable remissions in individual patients suggesting that DAC may be an alternative to Aza or even a second choice after Aza failure.

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Acknowledgements

This study was performed on behalf of the German Cooperative Transplant Study Group. T. S. and G. K. would like to thank all members of the German Cooperative Transplant Study Group for their efforts in this study.

We also thank the staff of the transplant unit of the Department of Hematology, Oncology and Clinical Immunology at the University Hospital Düsseldorf for excellent patient care.

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Authors and Affiliations

  1. Department of Hematology, Oncology and Clinical Immunology, Medical Faculty, University of Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany

    Thomas Schroeder, Christina Rautenberg, Kathrin Nachtkamp, Mustafa Kondakci, Stefanie Geyh, Rainer Haas, Ulrich Germing & Guido Kobbe

  2. Clinic and Policlinic for Internal Medicine C, Hematology and Oncology, University of Greifswald, Greifswald, Germany

    William Krüger

  3. Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, Dresden, Germany

    Uwe Platzbecker & Martin Bornhäuser

  4. Department of Medicine II, University Hospital Frankfurt, Frankfurt am Main, Germany

    Gesine Bug & Juliane Steinmann

  5. Med. Clinic III, University Medicine Mannheim, Mannheim, Germany

    Stefan Klein

  6. Klinikum Frankfurt (Oder) GmbH, Med. Clinic I, Frankfurt (Oder), Frankfurt, Germany

    Olaf Hopfer

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  1. Thomas Schroeder
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  2. Christina Rautenberg
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Contributions

Conception and design: T. S., G. K.

Collection and assembly of data: T. S., G. K., C. R., W. K., U. P., G. B., J. S., S. K., O. H., K. N., M. K., S. G., R. H., U. G., M. B.

Data analysis and interpretation: T. S., G. K., R. H., U. G.

Manuscript writing: T. S., G. K.

Final approval of the manuscript: all authors

Corresponding author

Correspondence to Thomas Schroeder.

Ethics declarations

Written informed consent was obtained from patients who were alive at the time of data collection. The study was approved by the ethics committee of the Heinrich-Heine-University, Duesseldorf (approval number 5309).

Conflict of interest

T. S. had a consulting role and received financial travel support for Celgene Corporation, Germany, as well as lecture fees from Celgene Corporation, Germany, and Janssen-Cilag GmbH, Germany. C. R. received financial travel support from Celgene Corporation, Germany; U. P. received honorary and participated in advisory boards for Janssen-Cilag GmbH, Germany. G. B. received financial travel support, honoraria, and research funding from Celgene Corporation, Germany. M. B. received lecture fees from Janssen-Cilag GmbH, Germany. U. P. had a consulting role for Celgene Corporation, Germany, and received honoraria and research funding from Celgene Corporation, Germany. K. N. received financial travel support from Celgene Corporation, Germany. G. K. received financial travel support, research funding, and lecture fees from Celgene Corporation, Germany. W. K., S. K., O. H., J. S., M. K., S. G., U. G., and R. H. have nothing to disclose.

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Schroeder, T., Rautenberg, C., Krüger, W. et al. Treatment of relapsed AML and MDS after allogeneic stem cell transplantation with decitabine and DLI—a retrospective multicenter analysis on behalf of the German Cooperative Transplant Study Group. Ann Hematol 97, 335–342 (2018). https://doi.org/10.1007/s00277-017-3185-5

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