Chemotherapy and donor peripheral blood progenitor cells for acute leukemia in early relapse after allogeneic bone marrow transplantation.
Ten patients with acute leukemia (AL) in early relapse after allo-BMT were treated with a modified MEC (mitoxantrone, etoposide and Ara-C) regimen followed by donor PBPC collected after mobilization with G-CSF. Seven patients achieved CR or had normal hemopoietic reconstitution: two had an early relapse at days +53 and +48, two patients died from acute GVHD at days +31 and +96, one died of interstitial pneumonia at day +55, and two patients experienced long-term survival. One patient with refractory disease and nodal involvement who did not respond to the first BMT had overt expansion of the leukemia at day +36; one patient with Ph+ ALL and one with ANLL evolving from MDS, both with skin involvement, had blast cells in peripheral blood at day +27 and +26, respectively. Transient cytopenia occurred in all patients; a normal granulocyte and platelet count was achieved within 3 weeks in all patients but one; acute GVHD occurred in six patients, and four had chronic GVHD. This approach is feasible in patients in early relapse after allo-BMT. It assists prompt re-establishment of normal donor hematopoiesis avoiding the prolonged cytopenia observed after donor lymphocyte infusion in AL patients relapsed after allo-BMT.
Alessandrino
E P
EP
Istituto di Ematologia, Università di Pavia, Italy.
Bernasconi
P
P
Caldera
D
D
Colombo
A
A
Malcovati
L
L
Martinelli
G
G
Bonfichi
M
M
Pagnucco
G
G
Salvaneschi
L
L
Bernasconi
C
C
D000208:Acute Disease; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000276:immunology / Q000473:pathology; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000139:chemically induced / Q000401:mortality; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007938:Leukemia / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D008942:Mitoxantrone / Q000627:therapeutic use; D012008:Recurrence; D013997:Time Factors; D014019:Tissue Donors; D018183:Transplantation Chimera; D014184:Transplantation, Homologous
D003561:Cytarabine; D016179:Granulocyte Colony-Stimulating Factor; D005047:Etoposide; D008942:Mitoxantrone