Sustained molecular remission in a patient with CML in blastic crisis receiving dose-reduced hematopoietic stem-cell transplantation followed by early withdrawal of cyclosporine and prophylactic use of interferon-alpha.
A 54-year-old man with chronic myelocytic leukemia in blastic phase received reduced-intensity transplantation (RIST) from an HLA-identical unrelated donor. The preparative regimen consisted of busulfan, fludarabine, and anti-thymocyte globulin. Graft-versus-host disease (GVHD) prophylaxis was cyclosporine alone. Because he had a high risk of relapse, we discontinued cyclosporine on day 37, but he did not develop any signs of acute GVHD. To induce GVHD and augment a graft-versus-leukemia effect, we initiated interferon-alpha therapy on day 80 to a maximum dosage of three million units five times a week. He achieved molecular remission on day 94 followed by the development of extensive chronic GVHD the severity of which paralleled to the dose of interferon-alpha GVHD gradually subsided after discontinuation of interferon-alpha and the patient remains in molecular remission 18 months after transplantation. This case suggests that early withdrawal of cyclosporine and the prophylactic use of interferon-alpha are promising in RIST for high-risk leukemia.
Hamaki
Tamae
T
Department of Hematology, Toranomon Hospital, Tokyo, Japan.
Kami
Masahiro
M
Momomura
Shin-ichi
S
Mineishi
Shin
S
Kusumi
Eiji
E
Kanda
Yoshinobu
Y
Ueyama
Jun-ichi
J
Miyakoshi
Shigesaburo
S
Morinaga
Shin-ichi
S
Takaue
Yoichi
Y
Mutou
Yoshitomo
Y
D001752:Blast Crisis / Q000601:surgery*; D016572:Cyclosporine / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D006086:Graft vs Host Disease / Q000503:physiopathology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D016898:Interferon-alpha / Q000627:therapeutic use*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D012074:Remission Induction
D007166:Immunosuppressive Agents; D016898:Interferon-alpha; D016572:Cyclosporine