{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T12:14:46Z","timestamp":1782821686642,"version":"3.54.5"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Donor lymphocyte infusion (DLI) can enhance graft-versus-leukemia (GvL) effects following allogeneic hematopoietic stem cell transplantation (HSCT) in pediatric acute myeloid leukemia (AML). However, the optimal integration of azacitidine (Aza) with DLI in children remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed 16 pediatric AML patients (\u226418\u00a0years) treated at Fundeni Clinical Institute between 2016 and 2024 who received DLI in combination with azacitidine (75\u00a0mg\/m\n                      <jats:sup>2<\/jats:sup>\n                      \/day for 7\u00a0days every 4\u00a0weeks) after HSCT. DLI was administered prophylactically or preemptively based on mixed donor chimerism (MDC), measurable residual disease (MRD) positivity, or high-risk cytogenetics, or therapeutically for post-transplant relapse, with or without chemotherapy. Outcomes assessed included overall survival (OS), donor chimerism, relapse rate, and graft-versus-host disease (GVHD).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After a median follow-up of 46.5\u00a0months, five patients received prophylactic\/preemptive DLI and eleven received therapeutic DLI (seven with chemotherapy, four without). All patients in the prophylactic\/preemptive group achieved full donor chimerism and MRD negativity, with an OS of 80% at 2.7\u00a0years. In the therapeutic group, median OS was 23.8\u00a0months with chemotherapy and 13.8\u00a0months without. OS differences between groups were not statistically significant (p = 0.384). Acute GVHD occurred in two patients (12.5%) in the therapeutic + chemotherapy subgroup; no chronic GVHD or non-relapse mortality was observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Azacitidine combined with DLI is feasible and safe in pediatric AML after HSCT, particularly when applied prophylactically or preemptively to restore donor chimerism or eradicate MRD. Therapeutic use in overt relapse remains challenging and provides limited benefit. Prospective multicenter studies are needed to define optimal timing, dosing, and combination strategies for integrating azacitidine with DLI in this high-risk pediatric population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2025.1727492","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T06:36:45Z","timestamp":1767854205000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Donor lymphocyte infusion combined with azacitidine after allogeneic HSCT in pediatric AML: a single-center retrospective analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Ana Maria","family":"Bica","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andra Daniela","family":"Marcu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Georgiana","family":"Jercan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iuliana","family":"Iordan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea Nicoleta","family":"Serbanica","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Avramescu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matei","family":"Colita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delia Codruta","family":"Popa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ileana","family":"Constantinescu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra Mihaela","family":"Ichim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei","family":"Colita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca","family":"Colita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.3390\/cancers16071278","article-title":"Donor lymphocyte infusion in the treatment of post transplant relapse of acute myeloid leukemias and myelodysplastic syndromes significantly improves overall survival: a French\u2013Italian experience of 134 patients","volume":"16","author":"Accorsi Buttini","year":"2024","journal-title":"Cancers"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e183","DOI":"10.1016\/S2352-3026(17)30029-7","article-title":"Association between anti-thymocyte globulin exposure and survival outcomes in adult unrelated haemopoietic cell transplantation: a retrospective, pharmacodynamic cohort analysis","volume":"4","author":"Admiraal","year":"2017","journal-title":"Lancet Haematol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1038\/sj.bmt.1704444","article-title":"Increasing mixed chimerism defines a high-risk group of childhood acute myelogenous leukemia patients after allogeneic stem cell transplantation where pre-emptive immunotherapy may be effective","volume":"33","author":"Bader","year":"2004","journal-title":"Bone Marrow Transpl."},{"key":"B5","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-031-44080-9_21","article-title":"Documentation of engraftment and chimerism after HCT","volume-title":"The EBMT handbook: hematopoietic cell transplantation and cellular therapies","author":"Bader","year":"2024"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.3390\/jcm4061240","article-title":"Alternative donor transplantation for acute myeloid leukemia","volume":"4","author":"Bejanyan","year":"2015","journal-title":"J. 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