Treatment of relapsed acute lymphoblastic leukemia after allogeneic bone marrow transplantation with chemotherapy followed by G-CSF-primed donor leukocyte infusion: a prospective study
Treatment of relapsed acute lymphoblastic leukemia after allogeneic bone marrow transplantation with chemotherapy followed by G-CSF-primed donor leukocyte infusion: a prospective study
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DOI：
10.1038/sj.bmt.1705024
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发表时间：
2005-07-01
影响因子：
4.8
通讯作者：
Lee, KH
中科院分区：
文献类型：
--
作者：
Choi, SJ;Lee, JH;Lee, KH
对于异基因骨髓移植（BMT）后复发的急性淋巴细胞白血病（ALL）患者，单独进行供体白细胞输注（DLI）的疗效非常有限。因此，我们对10例异基因骨髓移植后复发的ALL患者进行了前瞻性的细胞减灭化疗（中剂量阿糖胞苷+伊达比啶+依托泊苷），随后立即进行G-CSF预充DLI（Chemo-DLI）的疗效。7例患者在DLI后中位25天（19-73天）达到完全缓解（CR）。在这7例CR患者中，只有1例在DLI后907天仍存活于CR。2例CR患者死于移植物抗宿主病CR。其余4例CR患者在DLI后中位数153天（120-991天）复发。一个在DLI后第1217天患有白血病。DLI后的中位生存期为175天（15-1217天）。总之，尽管同种异体BMT后复发ALL的化疗DLI诱导了相对较高的CR率，但持久缓解罕见。虽然我们的数据应谨慎解释，考虑到患者人数少，这些结果表明，DLI在复发性ALL中的不良结局可能主要是由于对移植物抗白血病效应的内在抵抗，而不是疾病的快速发展。
Donor leukocyte infusion (DLI) alone has very limited efficacy for patients with acute lymphoblastic leukemia (ALL) who have relapsed after allogeneic bone marrow transplantation (BMT). We, therefore, prospectively tested the efficacy of cytoreductive chemotherapy (intermediate-dose cytarabine+idarubicin+etoposide) followed immediately by G-CSF-primed DLI (Chemo-DLI) in 10 relapsed ALL patients after allogeneic BMT. Seven achieved complete remission (CR) at a median of 25 days (19-73 days) after DLI. Of these seven CR patients, only one remains alive in CR 907 days after DLI. Two CR patients died in CR of graft-versus-host disease. The remaining four CR patients relapsed at a median of 153 days (120-991 days) after DLI. One is alive with leukemia at post-DLI day 1217. The median survival duration after DLI was 175 days (15-1217 days). In summary, although Chemo-DLI for relapsed ALL after allogeneic BMT induced a relatively high CR rate, durable remissions were rare. Although our data should be interpreted cautiously considering the small number of patients, these results suggest that poor outcome of DLI in relapsed ALL may be primarily due to intrinsic resistance to graft-versus-leukemia effect rather than to the rapid pace of the disease.