Transfusion of donor buffy coat cells in the treatment of persistent or recurrent malignancy after allogeneic bone marrow transplantation.
BACKGROUND
Patients who experience relapse after allogeneic bone marrow transplantation have a poor prognosis. However, preclinical and clinical data have strongly suggested the existence of an immune-mediated anti-tumor effect of allogeneic bone marrow transplantation. This effect, termed graft-versus-leukemia, may be harnessed purposefully in patients with posttransplant relapses by the administration of immune cells obtained by leukapheresis of the original bone marrow donor.


METHODS
Thirteen patients with persistent or recurrent hematologic malignancy after HLA-matched sibling-donor allogeneic bone marrow transplantation were treated with transfusion of buffy coat cells collected from the original bone marrow donors. Mononuclear cell dose ranged from 1.18 to 4.28 x 10(8) per kg. Alpha-interferon (1.5-3 x 10(6) U/m2 3-5x/week) was given to seven patients. Patients were observed for the development of graft-versus-host disease and disease response.


RESULTS
Three of five patients with chronic myelogenous leukemia had complete remissions. One of five patients with active acute leukemia attained complete remission. A sixth acute leukemia patient treated with buffy coat transfusion after the induction of remission with chemotherapy relapsed 12 months later. One patient with myeloma had a complete but transient response. A patient with Hodgkin's disease did not respond. Four patients remain in remission 4, 16, 17, and 29 months after attaining complete remission. Graft-versus-host disease occurred in eight patients, including all of those with a complete response. One patient developed transient pancytopenia.


CONCLUSIONS
The transfusion of donor buffy coat cells has significant anti-tumor activity in patients with relapsed hematologic malignancy after allogeneic bone marrow transplantation. This effect is strongly associated with graft-versus-host disease.
Collins
R H
RH
Bone Marrow Transplantation Research, Baylor University Medical Center/Texas Oncology, Dallas, USA.
Pineiro
L A
LA
Nemunaitis
J J
JJ
Jain
V K
VK
Waxman
D
D
Miller
W V
WV
Fay
J W
JW
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D002678:Chimera; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D006801:Humans; D007938:Leukemia / Q000276:immunology / Q000628:therapy*; D017708:Leukocyte Transfusion / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012008:Recurrence