Effect of induced GVHD in leukemia patients relapsing after allogeneic bone marrow transplantation: single-center experience of 33 adult patients.
In a retrospective single center study, we examined the outcome of induced GVHD in leukemia patients relapsing after allogeneic BMT. Thirty-three adult patients with leukemia (15 AML, 3 ALL, and 15 CML) persisting or relapsing 1-36 months (median, 6) after allogeneic BMT underwent various immune manipulations and consequently developed acute and/or chronic GVHD at our center. Immunotherapies to elicit GVHD comprised chemotherapy followed by PBSC (n = 18), non-myeloablative transplant (n = 2), PBL followed by IFN-alpha (n = 5), PBL alone (n = 3), abrupt cessation of CsA (n = 3), and CsA withdrawal combined with IFN-alpha (n = 2). Twenty-four (72.7%) patients obtained a remission including complete hematological or cytogenetic remission, respectively, for acute leukemias or CML. Overall survival of patients, estimated at 3 years using the Kaplan-Meier method, was 33.9% (95% CI, 20-52%). Twelve patients including two patients with ALL remain in complete hematological (n = 5) or cytogenetic remission (n = 7) 3-93 months (median 12) after achieving remission. Twelve (63.2%) of 19 dead patients died due to treatment-related toxicities; five patients from acute GVHD, three from GVHD followed by infections and four from infections. By multivariate Cox analysis, only chronic GVHD resulted in a higher probability of disease-free survival (P = 0.026). Eight patients who had both acute GVHD < or = grade I and chronic GVHD are all alive without leukemia. We conclude that acute GVHD is associated with considerable toxicity while chronic GVHD plays a role in retaining remission in leukemia relapsing after allogeneic BMT.
Min
C K
CK
The Catholic Hemopoietic Stem Cell Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Eom
K S
KS
Lee
S
S
Kim
D W
DW
Lee
J W
JW
Min
W S
WS
Kim
C C
CC
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000633:toxicity; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D016572:Cyclosporine / Q000008:administration & dosage / Q000633:toxicity; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000401:mortality; D020544:Graft vs Leukemia Effect; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects; D016898:Interferon-alpha / Q000008:administration & dosage / Q000633:toxicity; D007938:Leukemia / Q000150:complications / Q000401:mortality / Q000628:therapy*; D017708:Leukocyte Transfusion / Q000009:adverse effects; D008297:Male; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000401:mortality
D000970:Antineoplastic Agents; D016898:Interferon-alpha; D016572:Cyclosporine