International Journal of Hematology

, Volume 88, Issue 3, pp 331–335

Case of a patient with Philadelphia-chromosome-positive acute lymphoblastic leukemia relapsed after myeloablative allogeneic hematopoietic stem cell transplantation treated successfully with imatinib and sequential donor lymphocyte infusions

  • Makoto Yoshimitsu
  • Hiroshi Fujiwara
  • Atsuo Ozaki
  • Heiichiro Hamada
  • Kakushi Matsushita
  • Naomichi Arima
  • Chuwa Tei
Case Report

DOI: 10.1007/s12185-008-0150-z

Cite this article as:
Yoshimitsu, M., Fujiwara, H., Ozaki, A. et al. Int J Hematol (2008) 88: 331. doi:10.1007/s12185-008-0150-z
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Abstract

A 23-year-old man with Philadelphia-chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) underwent myeloablative allogeneic hematopoietic stem cell transplantation (allo-HSCT) from his HLA-identical brother in first hematological remission following induction chemotherapy which included imatinib. He had no acute graft-versus-host disease (GVHD), and 4.5 months after HSCT, he had a molecular relapse (180,000 copies/μg RNA of minor bcr/abl transcripts (m-bcr/abl) without mutation in 22 sites including the p-loop region). Following discontinuation of cyclosporine A, imatinib (600 mg daily) was restarted and 4 days later donor lymphocyte infusion (DLI) (5 × 107/kg of CD3+ cells) was given. In 2 weeks, the marrow m-bcr/abl became undetectable. He received two further DLIs and imatinib was continued at a reduced dose of 400 mg a day. At the time of this report, he remains in complete hematological remission more than 33 months after allo-HSCT and persists in the second molecular remission for longer than 24 months. During this clinical course, he became positive for anti-nuclear antibody after second DLI, without any other manifestations of GVHD. The standard treatment for Ph+ ALL relapsing after allo-HSCT still remains to be established. Imatinib in combination with DLI for early molecular relapse may be a promising option.

Keywords

ImatinibDLIPh+ ALLRelapse post allo-HSCT

Copyright information

© The Japanese Society of Hematology 2008

Authors and Affiliations

  • Makoto Yoshimitsu
    • 1
  • Hiroshi Fujiwara
    • 2
  • Atsuo Ozaki
    • 1
  • Heiichiro Hamada
    • 1
  • Kakushi Matsushita
    • 1
  • Naomichi Arima
    • 3
  • Chuwa Tei
    • 4
  1. 1.Department of Hematology and ImmunologyKagoshima University HospitalKagoshimaJapan
  2. 2.Department of Bioregulatory Medicine, Graduate School of MedicineEhime UniversityShitsukawa, Toh-onJapan
  3. 3.Division of Host Response, Center for Chronic Viral Disease, Graduate School of Medical and Dental ScienceKagoshima UniversityKagoshimaJapan
  4. 4.Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of MedicineKagoshima UniversityKagoshimaJapan