Long-term remission of APL with a second allogeneic BMT after CNS relapse following HLA-identical allogeneic BMT.
Second allogeneic bone marrow transplantation (BMT) for AML relapsing after an initial BMT has a poor prognosis, with a probability of a 2-y disease-free survival below 30 per cent, caused both by treatment-related mortality (TRM) and high relapse rate. While TRM is most likely due to heavy pretreatment, AML relapse after BMT may be due to resistant disease or to a poor graft-versus-leukaemia (GvL) effect of the transplant. The degree of GvL may depend on individual donor/recipient immunoreactivity. In most published cases of second allogeneic BMT, both transplants were performed from the same donor. Here, we describe a patient who was first transplanted for acute promyelocytic leukaemia (APL) (AML FAB M3v) from his HLA-identical brother and received intensive immunotherapy including donor lymphocytes and IL2. He remained free from GvHD >I degrees, but developed CNS relapse. After a second BMT from another HLA-identical brother, he spontaneously developed GvHD III degrees, and has now been disease free for nearly 3 years. In this patient, long-term remission of AML relapsing after BMT was achieved by combining remission induction using an individual chemotherapy protocol with a second BMT from an alternative matched related donor and transient GvHD III degrees, which probably conferred a GVL effect.
Classen
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CF
University Children's Hospital Ulm, D-89070 Ulm, Germany. carl.classen@medizin.uni-ulm.de
Debatin
K-M
KM
Friedrich
W
W
Schulz
A S
AS
D016026:Bone Marrow Transplantation; D002490:Central Nervous System; D002675:Child, Preschool; D020544:Graft vs Leukemia Effect; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D015473:Leukemia, Promyelocytic, Acute / Q000276:immunology / Q000628:therapy*; D012008:Recurrence; D012074:Remission Induction; D014184:Transplantation, Homologous