Management of chronic myeloid leukaemia in relapse following donor lymphocyte infusion induced remission: a retrospective study of the clinical trials committee of the British Society of Blood & Marrow Transplantation (BSBMT)

Abstract

Summary:Donor lymphocyte infusion (DLI) can restore remission in a high percentage of patients with chronic myeloid leukaemia (CML) who relapse after allogeneic stem cell transplant (SCT). Subsequent relapses after a DLIinduced remission do occur and the optimal management of these patients is not defined. A retrospective study of the practice of UK transplant centres was conducted. In all, 13 patients from seven centres were identified: all were treated for relapse post allogeneic SCT with DLI and achieved either a complete cytogenetic (n ¼ 5) or molecular (n ¼ 8) remission. All patients subsequently had a second relapse, at molecular (n ¼ 7), cytogenetic (n ¼ 4) and haematological (n ¼ 2) levels. Further DLI was used in the treatment of 11 patients, imatinib mesylate in three and chemotherapy in two. The two patients with haematological relapse died of blastic disease. The remaining 11 patients achieved either a complete cytogenetic (n ¼ 2) or molecular (n ¼ 9) remission. Nine patients remain in molecular remission at a median follow-up of 29 months, seven of whom had received DLI alone as treatment for second relapse, one DLI plus imatinib and one imatinib alone. Toxicity following DLI for second relapse was low. Longer follow-up will be required to see if these second DLI-induced remissions will be durable.

Allogeneic stem cell transplantation for patients with chronic myeloid leukemia: Risk stratified approach with a long‐term follow‐up

“…It can be given as a ''bulk'' in a single dose or in escalated doses and is usually administered with or without imatinib if there is evidence of disease relapse [30][31][32][33]. Preemptive DLI, dictated by patients' PCR and/or cytogenetic status, has the advantage of treating only patients prone to relapse at MRD and avoiding unnecessary therapy in a substantial number of patients.…”

Molecular Monitoring of BCR-ABL Transcripts after Allogeneic Stem Cell Transplantation for Chronic Myeloid Leukemia

“…However, the predictive value of RT Q-PCR analysis on the risk of relapse after allogeneic HSCT is still debated [9]. This is particularly important as treatment of early (molecular or cytogenetic) relapses after allogeneic HSCT with either donor lymphocytes infusion [9][10][11] or TKIs has been shown to be more effective than late (advanced) relapses and to induce durable molecular responses [12][13][14]. In this article, we review the results of RT Q-PCR analysis of BCR-ABL transcripts in all patients with CML who underwent allogeneic HSCT at our institute, between 1983 and 2007, and correlate these results with the risk of relapse.…”