Treatment of relapsing leukemia after allogeneic blood stem cell transplantation by using dose-reduced conditioning followed by donor blood stem cells and GM-CSF

Citation
U. Platzbecker et al., Treatment of relapsing leukemia after allogeneic blood stem cell transplantation by using dose-reduced conditioning followed by donor blood stem cells and GM-CSF, ANN HEMATOL, 80(3), 2001, pp. 144-149
Citations number
27
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Hematology,"Cardiovascular & Hematology Research
Journal title
ANNALS OF HEMATOLOGY
ISSN journal
0939-5555 → ACNP
Volume
80
Issue
3
Year of publication
2001
Pages
144 - 149
Database
ISI
SICI code
0939-5555(2001)80:3<144:TORLAA>2.0.ZU;2-L
Abstract
Ten patients with high-risk acute myeloid leukemia (AML), chronic myeloid l eukemia (CML), and myelodysplastic syndrome (MDS) relapsing early (<1 year, n=8) or late (greater than or equal to1 year, n=2) after allogeneic transp lantation were treated with cytoreductive chemotherapy followed by unmanipu lated peripheral blood stem cell transplantation (PBSCT) from related (n=3) and unrelated donors (n=7). In order to enhance the grart-versus-leukemia effect, patients received no graft-versus-host disease (GVHD) prophylaxis a nd granulocyte-macrophage colony-stimulating factor (GM-CSF) was given at a dose of 60 mug/m(2) after transplant. Acute GVHD grade I-IV was seen in al l patients. Eight out of ten patients achieved complete remission: one out of two patients with AML and late relapse is in good condition with limited chronic GVHD more than 1 year after the second PBSCT. The other patient di ed on day +171 after the second PBSCT from cerebral aspergillosis. One pati ent with blastic phase CML achieved molecular remission but died +330 days after the second PBSCT because of intracranial bleeding. Of the remaining f ive patients, three died of infectious complications on days +36, +70, and +27, one patient died with extramedullary relapse on day +35, and one from multi-organ failure in association with acute GVHD on day +32 after the sec ond PBSCT. Two out of ten showed progressive disease and died on days +30 a nd +90, respectively. Although several patients achieved complete remission , the high risk of GVHD and treatment-related mortality should be kept in m ind, especially when a second transplant is considered during a period of l ess than 12 months after the first procedure. Monitoring of minimal residua l disease might predict relapse thus preventing high doses of cytotoxic dru gs for reconditioning. The potential of GM-CSF to enhance the graft-versus- leukemia reactivity after cytoreductive therapy for allogeneic transplantat ion warrants further investigation.