Prospective Trial of Chemotherapy and Donor Leukocyte Infusions for Relapse of Advanced Myeloid Malignancies After Allogeneic Stem-Cell Transplantation

• DOI: 10.1200/jco.2002.20.2.405
• Publication Date: 2017-02-24T07:59:20Z
• Authors: John E. Levine; Thomas Braun; Samuel L. Penza; Patrick Beatty; Kenneth Cornetta; Rodrigo Martino; William R. Drobyski; A. John Barrett; David L. Porter; Sergio Giralt; Jose Leis; Houston E. Holmes; Matthew Johnson; Mary Horowitz; Robert H. Collins
• Keywords: Immunosuppression

PURPOSE: Patients with advanced myeloid malignancies who experience relapse after allogeneic bone marrow transplantation (BMT) have a poor prognosis. Long-term survival chemotherapy alone, second myeloablative transplant, or donor leukocyte infusions (DLIs) alone is unusual. DLIs may minimal effectiveness in disease because adequate cellular responses are not able to develop the presence of bulky, fast-growing disease. A strategy was used debulk before administration granulocyte colony-stimulating factor (G-CSF)–primed DLIs. PATIENTS AND METHODS: Sixty-five patients experiencing hematologic malignancy HLA-matched sibling BMT were prospectively treated cytarabine-based chemotherapy, then G-CSF–primed No prophylactic immunosuppression provided. RESULTS: Twenty-seven 57 assessable experienced complete response. Graft-versus-host (GVHD) observed 56% patients. Treatment-related mortality 23%. Overall at 2 years for entire cohort 19%. response more likely survive, 1- and 2-year rates 51% 41%, respectively, median follow-up than years. The 1-year nonresponders 5%. posttransplant remission lasting 6 months associated higher likelihood GVHD required durable remission. CONCLUSION: Salvage treatment DLI can help some dependent on GVHD. short remissions unlikely benefit from this approach, approach significant treatment-related mortality. Modifications entirely different approaches will be most difficult clinical problem.