Treatment of leukemic relapse following unrelated umbilical cord blood transplantation with interleukin-2: potential for augmenting graft-versus-leukemia and graft-versus-host effects with cytokines.
In comparison to bone marrow, umbilical cord blood has decreased intrinsic immune responsiveness allowing transplantation across HLA barriers with lower rates of graft-versus-host disease. However, laboratory models have also suggested that cord blood may be extremely sensitive to stimulation by cytokines. We report an adult recipient of an ex vivo expanded, HLA-mismatched, unrelated cord blood transplant who experienced a late extramedullary relapse while still in hematologic remission. Despite demonstrating immune tolerance on minimal immunosuppressive agents, a brief course of intravenous interleukin-2 resulted in rapid, aggressive graft-versus-host and graft-versus-leukemia reactions. This case highlights the potential of cytokine immunomodulation following cord blood transplantation, but also suggests caution in stimulating these cells.
Goldberg
S L
SL
Adult Blood and Marrow Transplant Program, Hackensack University Medical Center, NJ, USA.
Pecora
A L
AL
Rosenbluth
R J
RJ
Jennis
A A
AA
Preti
R A
RA
D000276:Adjuvants, Immunologic / Q000009:adverse effects / Q000627:therapeutic use; D005312:Fetal Blood / Q000166:cytology* / Q000276:immunology; D006087:Graft vs Host Reaction / Q000187:drug effects* / Q000276:immunology; D020544:Graft vs Leukemia Effect / Q000187:drug effects* / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007376:Interleukin-2 / Q000009:adverse effects / Q000627:therapeutic use*; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D018183:Transplantation Chimera / Q000276:immunology; D023001:Transplantation Tolerance / Q000276:immunology
D000276:Adjuvants, Immunologic; D007376:Interleukin-2