Salvage chemotherapy with donor lymphocyte infusion and STI 571 in a patient relapsing with B-lymphoblastic phase chronic myeloid leukemia after allogeneic bone marrow transplantation

Abstract

Relapse is the main cause of treatment failure following hematopoietic stem cell transplantation for blastic phase chronic myeloid leukemia. Treatment options including donor lymphocyte infusion, second transplantation, interferon- and re-induction chemotherapy are often unsuccessful. We report a patient with blastic phase chronic myeloid leukemia relapsing after allogeneic stem cell transplantation. The post-transplant leukemia was characterized with B-lymphoid markers and multiple genetic abnormalities including double Ph-chromosomes. The disease was treated with three courses of salvage chemotherapy combined with donor lymphocyte infusion and bcr-abl tyrosine kinase inhibitor. The leukemia proved to be non-responsive both to immune therapy and STI 571. The presented case demonstrates the need for combination approaches in post-transplant relapsed leukemia and discusses the possible contributing mechanisms of STI-571 resistance.

Clinical outcome in chronic myeloid leukemia after allogeneic hematopoietic stem cell transplantation: the experience of the Bone Marrow Transplantation Unit of FUNFARME/BRAZIL using FISH

“…Patients who show the BCR/ABL rearrangement in progressively higher frequencies after the procedure are at greater risk of relapse and are candidates for additional and more aggressive therapies. However, patients with stable or decreasing frequencies seem to have immunological mechanisms suppressing the malignant clone, or perhaps this clone may lose its proliferative capacity resulting in a lower risk of relapse (Gopcsa et al, 2003).…”

“…Yang et al (2004) related a relapse rate at 2 years after the second allo-HSCT of 30%. The use of imatinib may also have a significant effect (Fujisawa et al, 2003;Gopcsa et al, 2003). Soydan et al (2005) concluded that imatinib treatment for molecular relapse after HSCT has an acceptable adverse event profile and provides a molecular remission rate of over 60%, but the response is short and 25% of the patients relapse again soon after drug cessation.…”