Treatment of relapse after allogeneic bone marrow transplantation with unmanipulated G-CSF-mobilized peripheral blood stem cell preparation

Abstract

Donor lymphocyte infusions (DLI) are an effective treatment of leukemia relapse after allogeneic bone marrow transplantation. Undesired side-effects are the development of graft-versus-host disease (GVHD) and the occurrence of pancytopenia in some patients. In a pilot study, we investigated if unmanipulated G-CSF-mobilized peripheral blood stem cells which naturally contain large numbers of T lymphocytes (D-PBSC/LI) would be equally effective or even superior than DLI in generating a graft-versus-leukemia reaction (GVL) but could mitigate or prevent the development of pancytopenia. We treated 12 patients with CML chronic phase (n = 5), CML blast crisis (n = 2), AML (n = 2), ALL (n = 1), CLL (n = 1) and multiple myeloma (n = 1). In five patients with acute leukemia or CML blast crisis D-PBSC/LI followed intensive chemotherapy (group A), in seven patients D-PBSC/LI were given without any prior chemotherapy (group B). In group A two patients were evaluable for hematologic toxicity. Leukopenia <1000/ μl lasted for 10 and 19 days, and thrombocytopenia <20 000/μl for 11 and 13 days, respectively. in group b leukopenia <1000/μl and thrombocytopenia <20 000/μl was observed in only one patient. moderate cytopenia developed in four of five evaluable patients. a complete remission could be achieved in all seven patients with cml who all developed acute and/or chronic gvhd. none of the remaining five patients achieved a complete remission despite acute and/or chronic gvhd in two of them. four patients died from disease progression, one patient from a secondary lymphoma, and one patient as a result of uncontrolled gvhd. in conclusion, d-pbsc/li is effective in inducing gvl reaction but it does not prevent pancytopenia in each case. it remains unclear if it mitigates the incidence and severity of pancytopenia.