title: Graft-versus-leukemia-induced complete remission following unrelated umbilical cord blood transplantation for acute leukemia.
abstract: A 15-year-old female received an unrelated three of six HLA antigen matched umbilical cord blood (UCB) transplant for refractory, relapsed T-cell ALL. Conditioning consisted of TBI, melphalan, and anti-thymocyte globulin (ATG), with cyclosporin A (CsA) and solumedrol for GVHD prophylaxis. She engrafted and a day 34 bone marrow aspirate showed 100% donor cells and no evidence of leukemia. The post-transplant course was complicated by mild grade I acute GVHD involving skin, and limited chronic GVHD of the gut which resolved with the addition of 1 mg/kg/day of steroids to her CsA prophylaxis. One hundred and ninety days after transplantation the patient developed pancytopenia and was subsequently found to have a leukemic relapse. Immunosuppression was discontinued and she was started on G-CSF and erythropoietin. Moderate skin and gut GVHD developed which was treated with both topical and low-dose oral steroids. Over the next few weeks she became transfusion independent and a follow-up bone marrow aspirate showed complete remission. She continued in complete remission for 4 months, at which time localized leukemic relapse was found in a soft tissue breast mass in spite of continued bone marrow remission. While the patient ultimately died of progressive disease, this case demonstrates that mismatched UCB in conjunction with G-CSF is capable of generating a GVL effect that can induce a complete remission.
authors.affiliation: Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
authors.forename: R P
authors.initials: RP
authors.lastname: Howrey
authors.forename: P L
authors.initials: PL
authors.lastname: Martin
authors.forename: T
authors.initials: T
authors.lastname: Driscoll
authors.forename: P
authors.initials: P
authors.lastname: Szabolcs
authors.forename: T
authors.initials: T
authors.lastname: Kelly
authors.forename: E J
authors.initials: EJ
authors.lastname: Shpall
authors.forename: S I
authors.initials: SI
authors.lastname: Bearman
authors.forename: V
authors.initials: V
authors.lastname: Slat-Vasquez
authors.forename: P
authors.initials: P
authors.lastname: Rubinstein
authors.forename: C E
authors.initials: CE
authors.lastname: Stevens
authors.forename: J
authors.initials: J
authors.lastname: Kurtzberg
mesh_terms: D000293:Adolescent; D005260:Female; D005312:Fetal Blood / Q000276:immunology*; D020544:Graft vs Leukemia Effect / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000276:immunology / Q000628:therapy*; D012074:Remission Induction