Background The ability of allogeneic bone marrow transplantationto cure chronic myeloid leukemia (CML) is due to both the conditioningregimen and the antileukemic effects of the lymphocytes in thegrafted marrow. We studied the ability of interferon alfa-2band infusions of mononuclear cells from the marrow donor toinduce a graft-versus-leukemia reaction in patients with CMLin relapse after bone marrow transplantation.
Methods Eleven patients with relapsed CML after allogeneic bonemarrow transplantation were treated with interferon alfa-2band infusions of mononuclear cells. The patients were monitoredfor toxic effects, for hematologic and cytogenetic responses,and, with use of the polymerase chain reaction, for eliminationof cells containing the bcr/abl messenger RNA transcript characteristicof the leukemic cells.
Results Six of the eight patients with stable CML after relapsehad complete remissions according to molecular genetic criteria,since no cells with bcr/abl messenger RNA transcripts were detected(the method can identify 1 leukemic cell among 1 million normalcells). The three patients with accelerated CML after relapsedid not enter remission. Myelosuppression was prominent in eightpatients. Grade I acute graft-versus-host disease (GVHD) occurredin six patients, and grade III acute GVHD occurred in three.Limited chronic GVHD developed in five patients.
Conclusions The induction of a graft-versus-leukemia reactionwith interferon alfa-2b and infusions of donor mononuclear cellsin patients with CML in relapse after bone marrow transplantationis an effective antileukemic therapy that may offer an alternativeto a second marrow transplantation.
Source Information
From the Division of Hematology-Oncology, Brigham and Women's Hospital and Harvard Medical School, Boston (D.L.P., C.M., J.L.M.F., J.H.A.), and the Division of Hematology-Oncology, University of Michigan Medical Center, Ann Arbor (M.S.R.).
Address reprint requests to Dr. Antin at the Division of Hematology-Oncology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115.
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