Role of postinduction immunotherapy in acute myeloid leukemia.
Because chemotherapy alone does not eliminate clonogenic leukemic cells, disease may recur after induction and consolidation chemotherapy. Studies of patients receiving high-dose chemotherapy supported by bone marrow or blood stem-cell transplantation suggest that immune-mediated effects of transplanted cells help control disease. This antileukemic (graft-versus-leukemia) effect represents several immune reactions. Various approaches to introduce or enhance such immune reactivity in patients with acute myeloid leukemia (AML) are being explored. There is some indication, even in older patients, that immunotherapy is better tolerated than chemotherapy, and efforts are underway to find the most effective treatment for maintaining remission after induction chemotherapy. We have developed a strategy that combines myeloablative chemotherapy with transplantation of autologous stem cells that have been cultured for 1 week in interleukin-2. Low-dose interleukin-2 is also administered for the first week after stem cell infusion. Although all patients developed side effects of fever and fatigue, even older patients tolerated this regimen well. The 3-year disease-free survival rate in a high-risk patient group transplanted in early first remission is 41 percent. Several other compounds are being investigated for their ability to enhance immune reactions after induction chemotherapy for AML. Although immunotherapy cannot eliminate overt leukemia and cytoreductive treatment is still needed initially, immunotherapy may find a place in postinduction management of AML to eliminate minimal (residual) disease or control its growth.
Klingemann
H G
HG
University of British Columbia, Vancouver Hospital and Health Sciences Centre, Canada.
D000208:Acute Disease; D001752:Blast Crisis; D016026:Bone Marrow Transplantation; D002986:Clinical Trials as Topic; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007167:Immunotherapy; D007376:Interleukin-2 / Q000627:therapeutic use; D007951:Leukemia, Myeloid / Q000473:pathology / Q000628:therapy*; D012074:Remission Induction
D007376:Interleukin-2