Interferon-α And Donor Buffy Coat Transfusions For Treatment Of Relapsed Chronic Myeloid Leukemia After Allogeneic Bone Marrow Transplantation

Hertenstein, Bernd; Wiesneth, Markus; Novotny, Juergen; Bunjes, Donald; Štefanič, Martin; Heinze, B; Hübner, G; Heimpel, Hermann; Arnold, Roland R.

doi:10.1097/00007890-199311000-00013

Cited by 81 publications

(32 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[1][2][3][4][5][6][7][8][9] The response to DLI is often associated with the development of GVHD, but the incidence of severe GVHD is reduced when an escalating dose rather than a bulk dose regimen is used. 11,13 However, it is not clear if an escalating dose regimen can induce durable remissions or is suitable for all patients.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Because the probability of response decreases with the disease progression, molecular/cytogenetic monitoring of the disease after transplantation and prompt therapy with DLI before the development of hematologic relapse may represent the optimal management of patients after transplantation. 7 The efficacy of DLI in CML has been limited to some extent by the morbidity and mortality associated with graft-versus-host disease (GVHD) and myelosuppression, which are frequently observed in responding patients.…”

Section: Introductionmentioning

confidence: 99%

“…7 The efficacy of DLI in CML has been limited to some extent by the morbidity and mortality associated with graft-versus-host disease (GVHD) and myelosuppression, which are frequently observed in responding patients. [1][2][3][4][5][6][7] The overall probability of mortality in remission was reported to be as high as 18% at 2 years in 2 separate surveys conducted in Europe and North America. 8,9 From retrospective data, it might be anticipated that giving DLI to patients in cytogenetic relapse rather than at later stages would significantly reduce the risk of developing bone marrow aplasia, but would not affect the risk of acute GVHD.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Donor lymphocyte infusion for relapsed chronic myelogenous leukemia: prognostic relevance of the initial cell dose

Guglielmi

Arcese²,

Dazzi

et al. 2002

Blood

177

110

View full text Add to dashboard Cite

were given to 62%, 20%, and 5% of patients in groups A, B, and C, respectively. A lower ICD was associated with less graft-versus-host disease (GVHD; A, 26%; B, 53%; C, 62%; P < .001), less myelosuppression (A, 10%; B, 23%; C, 24%; P ‫؍‬ .01), and similar response rate (A, 78%; B, 73%; C, 70%; P ‫؍‬ .48). Nonadjusted estimates of 3-year survival, failurefree survival, and DLI-related mortality were 84%, 66%, and 5% respectively, in group A; 63%, 57%, and 20% in group B; and 58%, 45%, and 22% in group C. Outcome analysis was adjusted for patient age, donor type, sex of donor, sex mismatch, disease phase at transplantation, T-cell depletion, interval from transplantation to DLI, GVHD prior to relapse, relapse type, and date of DLI. After adjustment, lower ICD was associated with less GVHD, less myelosuppression, same response rate, better survival, better failure-free survival, and less DLI-related mortality. Our results suggest that the first DLI dose should not exceed 0.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Donor lymphocyte infusion for relapsed chronic myelogenous leukemia: prognostic relevance of the initial cell dose

Guglielmi

Arcese²,

Dazzi

et al. 2002

Blood

177

110

View full text Add to dashboard Cite

show abstract

“…patients, with response rates ranging between 30 and 90%. [5][6][7][8][43][44][45][46][47][48] Contrary to other studies, we found a durable Second transplants are associated with a higher risk of Table 6 Influence of T cell-depleted (TCD) or non-TCD bone marrow transplantation on the remission inducing effect of interferon-␣ in CML patients therapy-associated mortality 3,17 and survival rates of frequencies of minimal residual disease and mixed chimerism in the early post-transplant period and may therefore between 30 and 60% have been described for CML patients at 24 months after a second transplant. Three of six patients support an enhanced antileukemic efficiency.…”

Section: Second Transplantsmentioning

confidence: 99%

A retrospective single centre study of the outcome of five different therapy approaches in 48 patients with relapse of chronic myelogenous leukemia after allogeneic bone marrow transplantation

Elmaagacli

Beelen

Schaefer

1997

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:ated allogeneic BMT and in 40-60% of patients treated in advanced disease stages. Relapse rates of 40-60% are also In a retrospective single centre study we examined the found in patients in 1st CP when a T cell-depleted BMT outcome of five different therapy approaches in 48 has been performed. 1,2 patients in whom a relapse of CML (13 cytogeneticThe treatment of relapsed CML patients after allogeneic relapses, 35 hematological relapses: 10 chronic phase BMT often has a poor outcome. The best outcome is found (CP), nine accelerated phase, 16 blast crisis) occurred in patients with an isolated cytogenetic relapse in whom a after allogeneic BMT. Cyclosporin A (CsA) withdrawal, spontaneous partial or complete disappearance of the Philainterferon alpha-2b (IFN-␣) therapy, donor leukocyte delphia (Ph) chromosome-positive cells occurs without spetransfusions (DLT), second transplantation (2nd BMT), cific treatment. These patients have the highest survival and chemotherapy (CTX) alone were used and studied probability of 50% after 6 years, as compared to 30% of for their response rates. Patients who achieved a compatients relapsing hematologically in chronic stage and 0% plete hematologic and cytogenetic remission (CR) were of patients in advanced stage (accelerated phase (AP) or studied for BCR-ABL transcripts and for their chimerblast crisis (BC) ). Patients with CML in an advanced disism status by PCR. A strong antileukemic effect was ease stage generally do not survive more than 3.5 years observed after abrupt CsA withdrawal, with 10 of 20 after a post-transplant relapse. Furthermore, this group of patients achieving a CR (50%). All 10 patients with patients has the poorest response rate to all post-transplant early stage (nine cytogenetic and one CP), but none of therapeutic approaches. 3,4 the patients with advanced disease recurrence, Based on the stimulation of an allogeneic immune moduresponded to CsA withdrawal. IFN-␣ induced in five of lating reaction which causes a GVL effect, several thera-11 patients (45%) a stable cytogenetic remission, peutic options exist for the treatment of relapsed CML after whereas treatment with DLT induced a CR in only two allogeneic BMT. Various studies have demonstrated that of 14 patients (14%). A second transplant was perforthe administration of either donor leukocytes (DLT) or med in six patients. Three of six patients (50%) survive interferon-alpha (IFN-␣), leads to complete cytogenetic disease-free at a median of 19 months after the 2nd remission in patients with hematologic relapses after BMT (range 10-25). The use of CTX alone did not BMT. [5][6][7][8][9][10][11] According to single case reports, complete cytoinduce a remission.genetic remissions can also be achieved by the withdrawal Keywords: CML; relapse; interferon; cyclosporine; BMT of cyclosporin A (CsA) after allogeneic BMT. [12][13][14][15][16] Furthermore, a second allogeneic transplant with bone marrow or peripheral blood progenitor cells still offers a Allogeneic bone marrow transplantation (BMT) is th...

show abstract

“…Although adoptive immunotherapy with donor lymphocytes has proven effective, it is complicated by GVHD in approximately 60% of patients. [8][9][10][11][12][13][14][15][16][17][18][19] The reported experience with this new form of treatment has been mainly confined to patients who were transfused with cells from sibling donors. Only 30-40% of patients have a genotypically HLA-identical donor available for allogeneic marrow grafting.…”

mentioning

confidence: 99%

Adoptive immunotherapy for relapse of chronic myeloid leukemia after allogeneic bone marrow transplant: equal efficacy of lymphocytes from sibling and matched unrelated donors

Rhee

Savage

Blackwell

et al. 1998

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:Lymphocyte transfusion from the marrow donor (DLT) is well established as an effective therapy for relapse of CML post allogeneic BMT. Reports thus far have been mostly limited to patients who received DLT from a matched sibling donor. We compared the efficacy and toxicity of DLT in 30 patients who were treated with cells from their HLA-identical sibling (n = 18) or from their phenotypically HLA-matched unrelated marrow donor (n = 12). The overall probability of obtaining a cytogenetic remission was 69% (95%CI: 51-83%) and was not significantly different between the two groups. The disease stage at the time of DLT was the only factor associated with cytogenetic remission by multivariate analysis; patients treated in cytogenetic or molecular relapse (n = 11) were seven times more likely (RR = 7.4, 95%CI: 2.4-22.4, P = 0.0005) to respond compared to patients treated for hematologic relapse (n = 19). There was a trend towards more acute GVHD II-IV in the unrelated donor group (58 vs 39%, P = 0.09), but the probability of developing extensive chronic GVHD was not significantly different (56 vs 39%, P = 0.4). We conclude that transfusion of donor cells from HLAmatched volunteer donors does not appreciably increase the risk of GVHD compared with transfusion of cells from HLA-identical siblings in patients with CML who relapse following allogeneic BMT. Conversely, there is no evidence for an increased graft-versus-leukemia effect after DLT from volunteer donors.

show abstract

Interferon-α And Donor Buffy Coat Transfusions For Treatment Of Relapsed Chronic Myeloid Leukemia After Allogeneic Bone Marrow Transplantation

Cited by 81 publications

References 0 publications

Donor lymphocyte infusion for relapsed chronic myelogenous leukemia: prognostic relevance of the initial cell dose

Donor lymphocyte infusion for relapsed chronic myelogenous leukemia: prognostic relevance of the initial cell dose

A retrospective single centre study of the outcome of five different therapy approaches in 48 patients with relapse of chronic myelogenous leukemia after allogeneic bone marrow transplantation

Adoptive immunotherapy for relapse of chronic myeloid leukemia after allogeneic bone marrow transplant: equal efficacy of lymphocytes from sibling and matched unrelated donors

Contact Info

Product

Resources

About