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Venetoclax and donor lymphocyte infusion for early relapsed acute myeloid leukemia after allogeneic hematopoietic cell transplantation. A retrospective multicenter trial

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Abstract

Prognosis in patients with post allogeneic HCT-early relapse of acute myeloid leukemia (<6 months post HCT) is dismal and response to salvage treatment is < 20%. In addition, majority of patients at this early point are unable to withstand intensive salvage chemotherapy. We hypothesized that the combination of donor lymphocyte infusion (DLI) and venetoclax may result in increased response in this difficult to treat patient group. We retrospectively analyzed 22 patients from February 2017–December 2019, who were given the Venetoclax/DLI combination. Median age was 65 (43–75) years. There were no cases of tumor lysis syndrome. Microbiology documented infections occurred in 8 patients (36%). Majority were able to tolerate the protocol without admissions. Acute GVHD was observed in 4 (18%) patients and cGVHD was observed in 6 (27%) patients. Overall response was observed in 11 (50%) patients (CR, n = 4; CRi, n = 1; CRp, n = 4; MLFS n = 2). Median time to response was 28 (18–67) days and median cycles of venetoclax 2 [1–8] and duration of response were 135 (31–564) days. Median survival was 6.1 months (95% CI .73–11.4). Cox regression model for survival showed decreased WBC at relapse, GVHD and better performance status were associated with better survival. These results may endorse the hypothesis that enhancing alloreactivity combined with venetoclax is safe and efficacious and should be further investigated in prospective trials.

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Authors and Affiliations

  1. BMT Unit, Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv, Israel

    Odelia Amit, Yael Bar On & Ron Ram

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Odelia Amit, Yael Bar On, Liat Shargian-Alon, Moshe Yeshurun & Ron Ram

  3. BMT Unit, Soroka Medical Center, Beer Sheva, Israel

    Galit Perez

  4. Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Tel Aviv, Israel

    Liat Shargian-Alon & Moshe Yeshurun

Authors
  1. Odelia Amit
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  2. Yael Bar On
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  3. Galit Perez
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  4. Liat Shargian-Alon
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  5. Moshe Yeshurun
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  6. Ron Ram
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Odelia Amit and Ron Ram. The first draft of the manuscript was written by Odelia Amit and edited by Ron Ram. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Odelia Amit.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee – Tel Aviv Sourasky Medical Center, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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All authors (Odelia Amit, Yael Bar On, Galit Perez, Liat Shargian-Alon, Moshe Yeshurun, Ron Ram) declare no conflict of interest.

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Amit, O., On, Y.B., Perez, G. et al. Venetoclax and donor lymphocyte infusion for early relapsed acute myeloid leukemia after allogeneic hematopoietic cell transplantation. A retrospective multicenter trial. Ann Hematol 100, 817–824 (2021). https://doi.org/10.1007/s00277-021-04398-y

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  • DOI: https://doi.org/10.1007/s00277-021-04398-y

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