Treatment of relapsed acute lymphoblastic leukemia after allogeneic bone marrow transplantation with chemotherapy followed by G-CSF-primed donor leukocyte infusion: a prospective study.

Abstract

Donor leukocyte infusion (DLI) alone has very limited efficacy for patients with acute lymphoblastic leukemia (ALL) who have relapsed after allogeneic bone marrow transplantation (BMT). We, therefore, prospectively tested the efficacy of cytoreductive chemotherapy (intermediate-dose cytarabine+idarubicin+etoposide) followed immediately by G-CSF-primed DLI (Chemo-DLI) in 10 relapsed ALL patients after allogeneic BMT. Seven achieved complete remission (CR) at a median of 25 days (19-73 days) after DLI. Of these seven CR patients, only one remains alive in CR 907 days after DLI. Two CR patients died in CR of graft-versus-host disease. The remaining four CR patients relapsed at a median of 153 days (120-991 days) after DLI. One is alive with leukemia at post-DLI day 1217. The median survival duration after DLI was 175 days (15-1217 days). In summary, although Chemo-DLI for relapsed ALL after allogeneic BMT induced a relatively high CR rate, durable remissions were rare. Although our data should be interpreted cautiously considering the small number of patients, these results suggest that poor outcome of DLI in relapsed ALL may be primarily due to intrinsic resistance to graft-versus-leukemia effect rather than to the rapid pace of the disease.

• Authors: S-J Choi, J-H Lee, J-H Lee, S Kim, Y-S Lee, M Seol, S-G Ryu, J-S Lee, W-K Kim, S Jang, C-J Park, H-S Chi, K-H Lee
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 36 Issue 2 Pg. 163-9 (Jul 2005) ISSN: 0268-3369 [Print] England
• PMID: 15937507 (Publication Type: Journal Article)

Chemical References

• Antineoplastic Agents
• Cytarabine
• Granulocyte Colony-Stimulating Factor
• Etoposide
• Idarubicin

Topics

• Adult
• Antineoplastic Agents (administration & dosage)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage)
• Bone Marrow Transplantation
• Cytarabine (administration & dosage)
• Etoposide (administration & dosage)
• Female
• Granulocyte Colony-Stimulating Factor (administration & dosage)
• Hematopoietic Stem Cell Mobilization (methods)
• Humans
• Idarubicin (administration & dosage)
• Leukocyte Transfusion
• Male
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (drug therapy, mortality, prevention & control)
• Prospective Studies
• Recurrence
• Tissue Donors
• Transplantation, Homologous
• Treatment Outcome