Abstract
During 1993 and 19% 90 patients (pis) with CML received an allogeneic bone marrow transplantation (bml). Median age at time of transplantation was 39 ( 1957) years. 29 pts received grafts from HLA-identical siblings. 10 from mismatched siblings or other family members, 47 from identical unrelated donors (urd), and 4 from mismatched urd. 54 pis were transplanted in chronic phase (stage 1 ). 23 pts in accleraled phase or second chronic phase (stage 2). and 13 pts in blast crisis or third chronic phase (stage 3). The conditioning regimens were TBI/Cyclophosphamide (72 pts) or BuniUan/Cyclophosphamide (18 pis). Additionally. 70 pis received Anti-Thymocyte-Globuline. Standard GVHD prophylaxis consisted of cyclosporine A and mahotrexate. Most of the patients were also enrolled in a placebo-controlled trial evaluating the prophylactic use of anti-TNF-a during conditioning. For follow-up after successful transplantation a semiquantitalrve nested bcr-abl PCR was employed. PCR products were evaluated after 30 and after 60 cycles of amplification 17 pis (19%) relapsed 3-28 (mean 9) months after bml 5 pts with stage 2 or 3 disease had an early fatal relapse and have either not been evaluated by PCR (2) or had negative (1) or positive (2) PCR results at one occasion. The remaining 12 pts with relapse have been followed by PCR closely. 1 pi had a molecular, cytogenetic and hématologie relapse 3 mo after BMT and received successful treatment with INF and donor leukocytes. Another pt progressed from molecular to hématologie relapse within 2 mo. She went in complete molecular remission by a 6-mo treatment with INF-a. 2 pts progressed from molecular to cytogenetic relapse and were successfully treated with INF-a. Cessation of immunosuppresston induced remission after molecular relapse in 2 pts. De novo arising GVHD induced remission after molecular relapse in 2 more pts. 3 pts who progressed from molecular to cytogenelic or hématologie relapse did not respond to INFa and 2 of them are now receiving donor leukocytes. 1 pt not eligible for immunomodulaling measures because of severe GVHD further progressed to blast crisis and is now receiving cytotoxic therapy. These data support the notion that molecular evidence of progressive disease should be used for early therapeutical intervention, i.e. withdrawel of immunosuppression or treatment with INFa.
Original language | English |
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Pages (from-to) | 906 |
Number of pages | 1 |
Journal | Experimental Hematology |
Volume | 25 |
Issue number | 8 |
State | Published - 1997 |
Externally published | Yes |