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Previous Volume 329:757-761 September 9, 1993 Number 11 Next

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ABSTRACT

Background Patients whose leukemia relapses after allogeneic bone marrow transplantation have a poor prognosis; few respond to further chemotherapy, and almost none survive over the long term. We present preliminary observations on the use of filgrastim (granulocyte colony-stimulating factor) for relapse after transplantation.

Methods Seven female patients with leukemia (one with chronic myelogenous leukemia, five with acute myelogenous leukemia, and one with a myelodysplastic syndrome that transformed into acute myelogenous leukemia) whose disease relapsed within 360 days after allogeneic bone marrow transplantation received filgrastim (5 µg per kilogram of body weight per day by subcutaneous injection) to reinduce remission by stimulating residual donor marrow cells. Cytogenetic analysis of bone marrow, fluorescence in situ hybridization, and determination of restriction-fragment-length polymorphisms were used to assess response and chimerism.

Results Three of the seven patients had a complete hematologic and cytogenetic remission, with reestablishment of hematopoiesis of donor origin. Mild chronic graft-versus-host disease developed in one patient, and acute graft-versus-host disease in none. One patient had a relapse 12 months after treatment, and two others remained in remission after 10 and 11 months. In two of the patients with a response, fluorescence in situ hybridization demonstrated stimulation of donor cells without differentiation of the leukemic clone.

Conclusions Filgrastim may be effective in selected cases of leukemic relapse after allogeneic bone marrow transplantation.

Source Information

From the Departments of Hematology (S.G., S.E., H.K., A.D., E.J.F., B.S.A., S.O., M.A., R.E.C.) and Laboratory Medicine (H.F., A.C., C.H.-G., J.T., S.S.), University of Texas M.D. Anderson Cancer Center, Houston.

Address reprint requests to Dr. Champlin at Bone Marrow Transplantation, Department of Hematology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030.

Full Text of this Article

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Treatment of Leukemia in Relapse after Bone Marrow Transplantation
de Witte T., Schattenberg T., Collins R. H., Fay J. W., Champlin R., Giralt S.
Extract | Full Text  
N Engl J Med 1994; 330:645-646, Mar 3, 1994. Correspondence

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