title: Non-leukemic autologous reconstitution after allogeneic bone marrow transplantation for Ph-positive chronic myelogenous leukemia: extended remission preceding eventual relapse.
abstract: Autologous reconstitution is the recovery of autologous hematopoietic function after failure of an allogeneic graft to establish sustained hematopoiesis either with or without preceding donor engraftment. We reviewed 9 years experience of the University of Minnesota and identified 10 of 291 patients who underwent allogeneic BMT for Ph-positive CML and developed non-leukemic autologous reconstitution. All patients received the same preparative regimen with cyclophosphamide and total body irradiation. Eight patients had a 6/6-antigen matched donor. Eight patients received their graft from an unrelated donor. In five cases the graft was T cell-depleted. Non-malignant autologous reconstitution initially manifested as mixed chimerism in nine of 10 patients and lasted for a median of 11 (3-41) months. Eight patients have relapsed and four are still alive. The two relapse-free patients have died 24 and 48 months post transplant. Of the four surviving patients, two are in interferon-induced cytogenetic remission at 53+ and 101+ months of follow-up. Autologous non-leukemic reconstitution is uncommon, but appears to be a distinct clinical syndrome, perhaps occurring more frequently after unrelated donor BMT. Although usually followed by relapse, relapse-free survival may be prolonged.
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis 55455, USA.
authors.forename: C G
authors.initials: CG
authors.lastname: Brunstein
authors.forename: B A
authors.initials: BA
authors.lastname: Hirsch
authors.forename: J S
authors.initials: JS
authors.lastname: Miller
authors.forename: R C
authors.initials: RC
authors.lastname: McGlennen
authors.forename: C M
authors.initials: CM
authors.lastname: Verfaillie
authors.forename: P B
authors.initials: PB
authors.lastname: McGlave
authors.forename: D J
authors.initials: DJ
authors.lastname: Weisdorf
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006412:Hematopoietic Stem Cells / Q000166:cytology / Q000276:immunology / Q000502:physiology*; D006801:Humans; D007223:Infant; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018183:Transplantation Chimera; D016896:Treatment Outcome