Extramedullary relapse after favorable molecular response to donor leukocyte infusions for recurring acute leukemia.

Abstract:

:Donor leukocyte infusions (DLI) have turned out to be an efficient way to re-establish complete remission (CR) in chronic myeloid leukemia (CML) patients relapsing after allogeneic bone marrow transplantation (BMT). In these patients, absence of PCR bcr-abl fusion transcripts confirmed the potency of donor leukocytes to induce molecular response in relapsed CML. This ensured sustained remission and long-term survival. In this study, the capacity of DLI to induce molecular remission in acute leukemia relapse after BMT was analyzed. The results showed that following DLI, leukemic cell eradication gradually occurred over a prolonged time period. The time to complete disappearance of the molecular marker of the disease was 30 weeks in RT-PCR analysis. A sustained and persistent elimination of an AML1/ETO-positive leukemic clone in an AML-M2 patient was observed. In contrast, an AML-M5 with t(11;19) and an E2A/PBX1-positive ALL achieving cytogenetic and molecular bone marrow CR developed following DLI unusual sites of extramedullary leukemia relapse, despite continued bone marrow remission. This study adds further proof of the benefit of donor cell therapy in acute leukemia but shows that complete leukemic cell eradication appears to require a critical interval in order to establish effective immune responses at all sites where leukemic cells persist.

journal_name

Leukemia

journal_title

Leukemia

authors

Berthou C,Léglise MC,Herry A,Balcon D,Hardy E,Lessard M,Abgrall JF

doi

10.1038/sj.leu.2401144

subject

Has Abstract

pub_date

1998-11-01 00:00:00

pages

1676-81

issue

11

eissn

0887-6924

issn

1476-5551

journal_volume

12

pub_type

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