{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T05:44:55Z","timestamp":1785908695169,"version":"3.56.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["JP25K10576"],"award-info":[{"award-number":["JP25K10576"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>\n                    Relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the leading cause of treatment failure in acute myeloid leukemia (AML), particularly in genetically adverse subtypes. Although prophylactic donor lymphocyte infusion (DLI) may augment graft-versus-leukemia effects, its stand-alone efficacy is suboptimal, necessitating rational combination approaches. Limited case reports have suggested potential clinical benefits of gemtuzumab ozogamicin (GO) in combination with DLI as salvage therapy for post-transplant relapse; however, its role in prophylactic maintenance has not been determined. We report a 29-year-old woman with chemo-refractory AML harboring t(1;3)(p36.3;q21) who relapsed approximately 3 months after her first allo-HSCT. She underwent a second haploidentical allo-HSCT without achieving remission beforehand. Given the extremely high risk of relapse, she received immune-directed maintenance with low-dose GO (3 mg\/m\n                    <jats:sup>2<\/jats:sup>\n                    on days 98 and 140 post-transplant) followed by dose-escalated DLI (six monthly infusions starting on day 374). Although the patient developed chronic graft-versus-host disease, including pulmonary involvement (NIH lung score 2), it remained clinically manageable. She maintained molecular complete remission for more than 6 years. Our case suggests that sequential low-dose GO followed by stepwise DLI may support durable remission when used as a post-transplant maintenance strategy in chemo-refractory AML with adverse cytogenetics, such as t(1;3)(p36.3;q21). This maintenance approach warrants further investigation to clarify feasibility and safety.\n                  <\/jats:p>","DOI":"10.3389\/fimmu.2026.1888993","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T04:50:39Z","timestamp":1785905439000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Immune-directed post-transplant maintenance with low-dose gemtuzumab ozogamicin and stepwise donor lymphocyte infusion in acute myeloid leukemia with t(1;3)(p36.3;q21)"],"prefix":"10.3389","volume":"17","author":[{"given":"Fumihiko","family":"Ouchi","sequence":"first","affiliation":[{"name":"Hematology Division, Tokyo Metropolitan Komagome Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuho","family":"Najima","sequence":"additional","affiliation":[{"name":"Hematology Division, Tokyo Metropolitan Komagome Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyoko","family":"Haraguchi","sequence":"additional","affiliation":[{"name":"Division of Transfusion and Cell Therapy, Tokyo Metropolitan Komagome Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daichi","family":"Sadato","sequence":"additional","affiliation":[{"name":"Clinical Research and Trials Center, Tokyo Metropolitan Komagome Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chizuko","family":"Hirama","sequence":"additional","affiliation":[{"name":"Clinical Research and Trials Center, Tokyo Metropolitan Komagome Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaoru","family":"Morita","sequence":"additional","affiliation":[{"name":"Hematology Division, Tokyo Metropolitan Komagome Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Toya","sequence":"additional","affiliation":[{"name":"Hematology Division, Tokyo Metropolitan Komagome Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Hematology Division, Tokyo Metropolitan Komagome Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomomi","family":"Toubai","sequence":"additional","affiliation":[{"name":"Hematology Division, Tokyo Metropolitan Komagome Hospital","place":["Tokyo, Japan"]},{"name":"Clinical Research and Trials Center, Tokyo Metropolitan Komagome Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hironori","family":"Harada","sequence":"additional","affiliation":[{"name":"Hematology Division, Tokyo Metropolitan Komagome Hospital","place":["Tokyo, Japan"]},{"name":"Laboratoty of Oncology, Tokyo University of Pharmacy & Life Sciences","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuka","family":"Harada","sequence":"additional","affiliation":[{"name":"Clinical Research and Trials Center, Tokyo Metropolitan Komagome Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriko","family":"Doki","sequence":"additional","affiliation":[{"name":"Hematology Division, Tokyo Metropolitan Komagome Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1038\/s41409-018-0171-z","article-title":"Epidemiology and biology of relapse after stem cell transplantation","volume":"53","author":"Horowitz","year":"2018","journal-title":"Bone Marrow Transplant"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2015.139105","article-title":"Risk factors for relapse after allogeneic transplantation in acute myeloid leukemia","volume":"101","author":"Ossenkoppele","year":"2016","journal-title":"Haematologica"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1002\/(sici)1098-2264(200003)27:3<229::aid-gcc2>3.0.co;2-0","article-title":"Identification of breakpoint cluster regions at 1p36.3 and 3q21 in hematologic Malignancies with t(1;3)(p36;q21)","volume":"27","author":"Shimizu","year":"2000","journal-title":"Genes Chromosomes Cancer"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1038\/sj.onc.1206923","article-title":"Molecular characterization of a t(1;3)(p36;q21) in a patient with MDS. 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