Successful treatment of hematological and extramedullary relapse of MLL-positive acute lymphoblastic leukemia after bone marrow transplantation using donor leukocyte infusion.
Low response rates (range: 0-33%) were reported in acute lymphoblastic leukemia (ALL) patients who relapsed after bone marrow transplantation (BMT) and received donor leukocyte infusions (DLI). We describe an ALL patient who presented with a relapse in blood, bone marrow, breast, and axillary nodes 3 months after BMT from an unrelated donor. She achieved a second hematological complete remission (CR) after chemotherapy, with persistence of MLL-AF4 transcript in the bone marrow. DLI induced a long-lasting molecular CR that persisted on day 630 of DLI and was associated with a grade III graft-versus-host disease, which was controlled by prednisone, cyclosporine, and infliximab. This case report suggests the existence of an important graft-versus-leukemia (GVL) effect in patients with ALL and adds evidence for the activity of DLI towards extrahematological recurrences and ALL patients carrying t(4;11).
Francesca
F
Patriarca
Alessandra
A
Sperotto
Cristina
C
Skert
Daniela
D
Damiani
Simonetta
S
Prosdocimo
Renato
R
Fanin
D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods*; D004268:DNA-Binding Proteins / Q000096:biosynthesis*; D005260:Female; D006411:Hematopoiesis, Extramedullary; D011495:Histone-Lysine N-Methyltransferase; D006801:Humans; D017708:Leukocyte Transfusion / Q000379:methods*; D008297:Male; D051788:Myeloid-Lymphoid Leukemia Protein; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D011519:Proto-Oncogenes; D014157:Transcription Factors / Q000096:biosynthesis*
D004268:DNA-Binding Proteins; C497422:KMT2A protein, human; D014157:Transcription Factors; D051788:Myeloid-Lymphoid Leukemia Protein; D011495:Histone-Lysine N-Methyltransferase