A retrospective single centre study of the outcome of five different therapy approaches in 48 patients with relapse of chronic myelogenous leukemia after allogeneic bone marrow transplantation

Bone Marrow Transplant. 1997 Dec;20(12):1045-55. doi: 10.1038/sj.bmt.1701026.

Abstract

In a retrospective single centre study we examined the outcome of five different therapy approaches in 48 patients in whom a relapse of CML (13 cytogenetic relapses, 35 hematological relapses: 10 chronic phase (CP), nine accelerated phase, 16 blast crisis) occurred after allogeneic BMT. Cyclosporin A (CsA) withdrawal, interferon alpha-2b (IFN-alpha) therapy, donor leukocyte transfusions (DLT), second transplantation (2nd BMT), and chemotherapy (CTX) alone were used and studied for their response rates. Patients who achieved a complete hematologic and cytogenetic remission (CR) were studied for BCR-ABL transcripts and for their chimerism status by PCR. A strong antileukemic effect was observed after abrupt CsA withdrawal, with 10 of 20 patients achieving a CR (50%). All 10 patients with early stage (nine cytogenetic and one CP), but none of the patients with advanced disease recurrence, responded to CsA withdrawal. IFN-alpha induced in five of 11 patients (45%) a stable cytogenetic remission, whereas treatment with DLT induced a CR in only two of 14 patients (14%). A second transplant was performed in six patients. Three of six patients (50%) survive disease-free at a median of 19 months after the 2nd BMT (range 10-25). The use of CTX alone did not induce a remission.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Algorithms
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Biomarkers, Tumor / analysis
  • Blast Crisis / drug therapy
  • Blast Crisis / therapy
  • Bone Marrow Transplantation* / adverse effects
  • Combined Modality Therapy
  • Cyclosporine / administration & dosage*
  • Disease Management
  • Disease-Free Survival
  • Female
  • Fusion Proteins, bcr-abl / genetics
  • Graft vs Host Disease / etiology
  • Graft vs Host Disease / prevention & control
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Immunologic Factors / therapeutic use*
  • Immunosuppressive Agents / administration & dosage*
  • Interferon alpha-2
  • Interferon-alpha / therapeutic use*
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / drug therapy
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / pathology
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / therapy*
  • Leukemia, Myeloid, Accelerated Phase / drug therapy
  • Leukemia, Myeloid, Accelerated Phase / therapy
  • Leukocyte Transfusion*
  • Male
  • Middle Aged
  • Neoplasm, Residual
  • Polymerase Chain Reaction
  • RNA, Messenger / analysis
  • RNA, Neoplasm / analysis
  • Recombinant Proteins
  • Recurrence
  • Remission Induction
  • Retrospective Studies
  • Salvage Therapy*
  • Survival Analysis
  • Treatment Outcome

Substances

  • Biomarkers, Tumor
  • Immunologic Factors
  • Immunosuppressive Agents
  • Interferon alpha-2
  • Interferon-alpha
  • RNA, Messenger
  • RNA, Neoplasm
  • Recombinant Proteins
  • Cyclosporine
  • Fusion Proteins, bcr-abl