Induction of molecular remission by donor peripheral blood leukocyte therapy in patients relapsing with extramedullary blastic phase chronic myeloid leukemia after allogeneic bone marrow transplantation.

Extramedullary relapses at uncommon sites after allogeneic stem cell transplantation

“…We report three patients with strictly localised extramedullary relapse of a haematological malignancy which progressed to systemic relapse in spite of local therapy Ϯ donor lymphocyte infusion. In contrast, Bashey et al 4 described two patients with Philadelphia-chromosome positive CML who relapsed with extramedullary manifestations after HLA-identical allogeneic BMT, with no cytogenetic or haematological evidence of relapse in the bone marrow. In both cases, remission was achieved by DLI, but both patients developed severe fatal GVHD.…”

T cell-based immunotherapy for cancer: a virtual reality?

“…The development of GVHD tends to correlate with the response to DLL 224 In a recently published series from 25 north American BMT programs involving 140 patients with CML, AML, and ALL, the effect of adoptive transfer of HLA‐identical related matched donor lymphocytes induced clinical responses in 60% of the CML patients 225 . Another series showed that DLI with graded doses of CD4+ cells up to 1.5 × 10 8 /kg induced clinical responses in 15 of 19 (79%) patients with early phase CML relapse; five of six patients with relapsed multiple myeloma responded to DLL 226 Measurements of mixed chimerism 227–232 or probes that detect bcr‐abl transcripts 233,234 showed disappearance of relapsing cells of host origin within weeks to months after DLL 222 …”