Preliminary results of treatment with filgrastim for relapse of leukemia and myelodysplasia after allogeneic bone marrow transplantation.
BACKGROUND
Patients whose leukemia relapses after allogeneic bone marrow transplantation have a poor prognosis; few respond to further chemotherapy, and almost none survive over the long term. We present preliminary observations on the use of filgrastim (granulocyte colony-stimulating factor) for relapse after transplantation.


METHODS
Seven female patients with leukemia (one with chronic myelogenous leukemia, five with acute myelogenous leukemia, and one with a myelodysplastic syndrome that transformed into acute myelogenous leukemia) whose disease relapsed within 360 days after allogeneic bone marrow transplantation received filgrastim (5 micrograms per kilogram of body weight per day by subcutaneous injection) to reinduce remission by stimulating residual donor marrow cells. Cytogenetic analysis of bone marrow, fluorescence in situ hybridization, and determination of restriction-fragment--length polymorphisms were used to assess response and chimerism.


RESULTS
Three of the seven patients had a complete hematologic and cytogenetic remission, with reestablishment of hematopoiesis of donor origin. Mild chronic graft-versus-host disease developed in one patient, and acute graft-versus-host disease in none. One patient had a relapse 12 months after treatment, and two others remained in remission after 10 and 11 months. In two of the patients with a response, fluorescence in situ hybridization demonstrated stimulation of donor cells without differentiation of the leukemic clone.


CONCLUSIONS
Filgrastim may be effective in selected cases of leukemic relapse after allogeneic bone marrow transplantation.
Giralt
S
S
Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Escudier
S
S
Kantarjian
H
H
Deisseroth
A
A
Freireich
E J
EJ
Andersson
B S
BS
O'Brien
S
S
Andreeff
M
M
Fisher
H
H
Cork
A
A
D000293:Adolescent; D000328:Adult; D001856:Bone Marrow Examination; D016026:Bone Marrow Transplantation; D002678:Chimera; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D017403:In Situ Hybridization; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy / Q000601:surgery; D007951:Leukemia, Myeloid / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000601:surgery; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy / Q000601:surgery; D011994:Recombinant Proteins / Q000627:therapeutic use; D012075:Remission, Spontaneous; D014184:Transplantation, Homologous
D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim