Preemptive interferon-α treatment could protect against relapse and improve long-term survival of ALL patients after allo-HSCT

Sining Liu, Xueyi Luo, Xiaohui Zhang, Lanping Xu, Yu Wang, Chenhua Yan, Huan Chen, Yuhong Chen, Wei Han, Fengrong Wang, Jingzhi Wang, Kaiyan Liu, Xiaojun Huang, Xiaodong Mo, Sining Liu, Xueyi Luo, Xiaohui Zhang, Lanping Xu, Yu Wang, Chenhua Yan, Huan Chen, Yuhong Chen, Wei Han, Fengrong Wang, Jingzhi Wang, Kaiyan Liu, Xiaojun Huang, Xiaodong Mo

Abstract

Relapse was the major cause of treatment failure in patients with acute lymphoblastic leukemia (ALL) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). We aimed to identify the efficacy and safety of preemptive interferon-α (IFN-α) treatment in ALL patients who had minimal residual disease (MRD) after allo-HSCT. Multiparameter flow cytometry and polymerase chain reaction assays were applied for MRD monitoring. Recombinant human IFN-α-2b injections were administered subcutaneously twice weekly in every 4 weeks cycle. Twenty-four (35.3%), 5 (7.4%), 6 (8.8%), and 13 (19.1%) patients achieved MRD negativity at 1, 2, 3, and > 3 months, respectively, after treatment. Seven patients showed grade ≥ 3 toxicities after IFN-α treatment. The 4-year cumulative incidence of total acute graft-versus-host disease (aGVHD), severe aGVHD, total chronic GVHD (cGVHD), and severe cGVHD after treatment was 14.7%, 2.9%, 40.0%, and 7.5%, respectively. The 4-year cumulative incidences of relapse and non-relapse mortality after treatment was 31.9% and 6.0%, respectively. The 4-year probabilities of disease-free survival and overall survival after IFN-α treatment were 62.1% and 71.1%, respectively. Thus, preemptive IFN-α treatment could protect against relapse and improve long-term survival for ALL patients who had MRD after allo-HSCT. The study was registered at https://ichgcp.net/clinical-trials-registry/NCT02185261" title="See in ClinicalTrials.gov">#NCT02185261 (09/07/2014).

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Univariate analysis for prognostic factors of preemptive IFN-α treatment: (A) relapse; (B) disease-free survival, and (C) overall survival.
Figure 2
Figure 2
Cumulative incidence of survival after MRD positivity between the preemptive IFN-α treatment group in the present study and those who had MRD but did not receive interventions in the historical cohort: (A) relapse; (B) non-relapse mortality; (C) disease-free survival, and (D) overall survival.
Figure 3
Figure 3
Diagram of patients enrolled.

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