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Long-term remission of APL with a second allogeneic BMT after CNS relapse following HLA-identical allogeneic BMT
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Long-term remission of APL with a second allogeneic BMT after CNS relapse following HLA-identical allogeneic BMT
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Long-term remission of APL with a second allogeneic BMT after CNS relapse following HLA-identical allogeneic BMT
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Journal Article
Long-term remission of APL with a second allogeneic BMT after CNS relapse following HLA-identical allogeneic BMT
2003
Overview
Second allogeneic bone marrow transplantation (BMT) for AML relapsing after an initial BMT has a poor prognosis, with a probability of a 2-y disease-free survival below 30 per cent, caused both by treatment-related mortality (TRM) and high relapse rate. While TRM is most likely due to heavy pretreatment, AML relapse after BMT may be due to resistant disease or to a poor graft-versus-leukaemia (GvL) effect of the transplant. The degree of GvL may depend on individual donor/recipient immunoreactivity. In most published cases of second allogeneic BMT, both transplants were performed from the same donor. Here, we describe a patient who was first transplanted for acute promyelocytic leukaemia (APL) (AML FAB M3v) from his HLA-identical brother and received intensive immunotherapy including donor lymphocytes and IL2. He remained free from GvHD >I°, but developed CNS relapse. After a second BMT from another HLA-identical brother, he spontaneously developed GvHD III°, and has now been disease free for nearly 3 years. In this patient, long-term remission of AML relapsing after BMT was achieved by combining remission induction using an individual chemotherapy protocol with a second BMT from an alternative matched related donor and transient GvHD III°, which probably conferred a GVL effect.
Publisher
Nature Publishing Group UK,Nature Publishing Group
Subject
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
/ Biological and medical sciences
/ Bone marrow, stem cells transplantation. Graft versus host reaction
/ Histocompatibility antigen HLA
/ Humans
/ Infant
/ Leukemia
/ Leukemia, Promyelocytic, Acute - immunology
/ Leukemia, Promyelocytic, Acute - therapy
/ Medicine
/ Patients
/ Transfusions. Complications. Transfusion reactions. Cell and gene therapy
