Bone Marrow Transplantation for Chronic Myelogenous Leukemia in Chronic Phase

Abstract

Data on 405 patients with chronic myelogenous leukemia who received bone marrow transplants in chronic phase were analyzed for factors predictive of outcome. The 4-year actuarial probability of relapse was 19% (95% confidence interval [CI], 12% to 28%) and of survival, 55%. In multivariate analyses the probability of relapse was higher for recipients of T-cell-depleted bone marrow compared with recipients of non-T-cell-depleted bone marrow (relative risk, 5.4; P less than 0.0001) and for patients who did not develop chronic graft-versus-host disease (95% CI, 50% to 60%) with patients who did (relative risk, 3.1; P less than 0.01). The probability of survival was lower for patients who developed moderate to severe acute graft-versus-host disease than for patients with no or mild acute graft-versus-host disease (relative risk, 3.7; P less than 0.0001), and in patients aged 20 or older than in younger patients (relative risk, 2.6; P less than 0.0002). Duration of disease before transplant was not associated with outcome. Bone marrow transplantation done in the chronic phase of chronic myelogenous leukemia offers some patients prolonged leukemia-free survival. The T-cell-depleted grafts are associated with an increased probability of relapse.

Cancer‐testis antigen expression and its epigenetic modulation in acute myeloid leukemia

“…The therapeutic efficacy of alloSCT strictly depends on tumorreactive T cells as a central component of the transplant [6][7][8][9]. However, the molecular structures targeted by leukemia-specific immune responses remain unknown.…”

Low dose interleukin‐2 following intensification therapy with high dose cytarabine for acute myelogenous leukemia in first complete remission

“…The notion that a graft-vs-leukemic effect is operative in allogeneic transplantation is derived from the clinical observations that patients with graft-vs-host disease experience a lower relapse rate, the relapse rate after T-cell depleted grafts is higher, the relapse rate after syngeneic transplant is higher than that after allogeneic transplant [7][8][9][10]. The biological basis for such a GVL effect is complicated, but involves cytotoxic immune effector cells which recognize either minor histocompatibility antigens and/or leukemicassociated antigens.…”

“…Immunotherapeutic approaches could include the use of antibodies against known antigens, [3] presentation of presumptive AML antigens as a vaccine, [4,5] or generalized stimulation of the immune system [6]. There is ample evidence for the existence of a graft-vs-leukemia (GVL) effect in allogeneic stem cell transplantation, including a high relapse rate after synergic transplantation, a lower relapse rate associated with graft vs host disease, and a higher relapse rate after Tcell depletion of donor cells [7][8][9][10]. Moreover, the success of adoptive immunotherapy (donor-lymphocyte infusion) in salvaging patients who relapse after allogeneic bone marrow transplantation [11]also suggests that leukemia cells can be eliminated by immunologic means.…”

CD6+ T cell-depleted allogeneic bone marrow transplantation for non-Hodgkin’s lymphoma

“…T cell depletion has been associated with an increased risk of relapse in patients transplanted for chronic myelogenous leukemia (CML). 19,20 The effect of T cell depletion on relapse of other leukemias is less clear. 21 Our own experience suggests favorable results with CD6 depletion of donor marrow for patients with acute leukemia transplanted in first remission.…”