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Therapy

Treatment of leukemic relapse after allogeneic stem cell transplantation with cytotoreductive chemotherapy and/or immunotherapy or second transplants

Leukemia volume 15, pages 355–361 (2001)Cite this article

Abstract

We analyzed toxicity and efficacy of chemotherapy (CT) or second stem cell transplantation (SCT) and/or immunotherapy defined as stop of immunosuppression (IS) or donor leukocyte infusion (DLI) in 47 patients relapsing with acute leukemia. Ten patients received no treatment and 14 patients were treated with CT only. In 12 patients IS was stopped and three of them received additional CT. Five patients received DLI after CT as consolidation and one patient as frontline therapy. Five patients received a second SCT. Median overall survival after relapse was 2 months for the untreated patients, 2 months for patients receiving CT only, 2 months in patients after cessation of IS, 17 months in DLI treated patients and three months in patients receiving a second SCT. Fourteen patients achieved remission after relapse. Two with CT (2, 2 months), three with SI (3, 19, 19+ months), six with DLI (3, 8, 9, 14, 20, 36 months) and three with second SCT (2, 4, 6 months). Conventional CT was able do re-establish donor hematopoiesis and patients achieving remission showed a significantly better survival than patients with refractory disease. Patients who were brought into remission by DLI or cessation of IS had a significantly better survival than patients who achieved remission with CT alone or a second SCT. We conclude that a selected group of patients achieving remission with regeneration of donor hematopoiesis following CT might benefit from immunotherapy as consolidation.

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Acknowledgements

We thank the dedicated nurses of our bone marrow transplantation program, our fellows and house-staff, the medical technicians, and the staff of the blood-bank for their technical assistance in bone marrow harvesting and their support with blood products, and Dr K Dieckmann for performing the total body irradiation. We thank Karin Winkler, Margit König, Dieter Prinz and Karin Moser for excellent technical assistance. This work was supported by the ‘Fonds zur Förderung der wissenschaftlichen Forschung’ (P09549-MED) and the ‘Jubiläumsfonds der österreichischen Nationalbank’.

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Authors and Affiliations

  1. Department of Medicine I, Bone Marrow Transplantation Unit, University of Vienna, Austria

    F Keil, E Prinz, P Kalhs, K Moser, W Rabitsch, H Loidolt, A Schulenburg, M Mitterbauer & HT Greinix

  2. Department of Medicine I, Division of Hematology and Hemostaseology, University of Vienna, Austria

    K Lechner & U Jäger

  3. Clinical Institute for Medical and Chemical Laboratory Diagnostic, University of Vienna, Austria

    I Schwarzinger & C Mannhalter

  4. Institute for Medical Biology, University of Vienna, Austria

    C Fonatsch

  5. Department of Transfusion Medicine, University of Vienna, Austria

    N Worel & P Höcker

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Keil, F., Prinz, E., Kalhs, P. et al. Treatment of leukemic relapse after allogeneic stem cell transplantation with cytotoreductive chemotherapy and/or immunotherapy or second transplants. Leukemia 15, 355–361 (2001). https://doi.org/10.1038/sj.leu.2402048

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