Treatment of chronic myeloid leukemia with autologous transplantation using peripheral blood stem cells or bone marrow cultured in IL-2 followed by IL-2, GM-CSF, and IFN-alpha administration.
Interleukin-2 (IL-2) is able to generate nonspecific cytotoxic effectors from hematopoietic precursors. We evaluated the feasibility and efficacy of chronic myeloid leukemia (CML) treatment with autologous hematopoietic stem cell transplantation (HSCT) using grafts cultured in IL-2 followed by immunotherapy with IL-2, granulocyte-macrophage colony-stimulating factor (GM-CSF), and interferon (IFN)-alpha. Eight patients with CML were enrolled: five in an accelerated phase and three in a chronic phase. They received peripheral blood stem cells (PBSC) or bone marrow (BM) cultured in a medium containing IL-2 for 24 h. A median of 1.29 x 10(6) CD34+ cells/kg were infused after conditioning with busulfan (12 16 mg/kg) in PBSC recipients. BM was infused without prior myeloablative therapy. The engraftment occurred with a median of 15 d. Engraftment failure developed in one patient. The transplantation was followed by a 1-mo regimen of IL-2 (0.5 x 10(6) IU/m(2) daily) and GM-CSF, and 6 mo of IFN-alpha. One complete and one transient minor cytogenetic remission were observed. At 24 mo after transplantation, two patients had died of progressive disease and one of infection. Five patients had stable disease in the chronic phase. Autologous transplantation using IL-2-activated graft is feasible and the subsequent IL-2, GM-CSF, and IFN-alpha administration has acceptable toxicity. However, no benefits in comparison with conventional autologous transplantation for CML were identified in our study.
Hájek
Roman
R
Department of Internal Medicine-Hematooncology, Masaryk University, Brno, Czech Republic. r.hajek@fnbrno.cz
Zácková
Daniela
D
Büchler
Tomás
T
Penka
Miroslav
M
Krahulcová
Eva
E
Korístek
Zdenĕk
Z
Vinklárková
Jaroslava
J
Adler
Jiri
J
Janovská
Eva
E
Indrák
Karel
K
Faber
Edgar
E
Doubek
Michal
M
Klabusay
Martin
M
Oltová
Alexandra
A
Kuglík
Petr
P
Bourková
Ludmila
L
Dusek
Ladislav
L
Mareschová
Iveta
I
Mayer
Jiri
J
Vorlícek
Jiri
J
D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods*; D018450:Disease Progression; D004334:Drug Administration Schedule; D005260:Female; D006082:Graft Enhancement, Immunologic / Q000379:methods*; D006085:Graft Survival / Q000187:drug effects; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage*; D006801:Humans; D007279:Injections, Subcutaneous; D016898:Interferon-alpha / Q000008:administration & dosage*; D007376:Interleukin-2 / Q000008:administration & dosage*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D010865:Pilot Projects; D012074:Remission Induction; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome
D016898:Interferon-alpha; D007376:Interleukin-2; D016178:Granulocyte-Macrophage Colony-Stimulating Factor