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International Journal of Hematology

, Volume 82, Issue 5, pp 449–455 | Cite as

Prospective Trial of High-Dose Chemotherapy Followed by Infusions of Peripheral Blood Stem Cells and Dose-Escalated Donor Lymphocytes for Relapsed Leukemia after Allogeneic Stem Cell Transplantation

  • Akiyoshi Takami
  • Hirokazu Okumura
  • Hirohito Yamazaki
  • Masahiro Kami
  • Song-Wong Kim
  • Hidesaku Asakura
  • Tomoyuki Endo
  • Mitsuyuki Nishio
  • Koichiro Minauchi
  • Koki Kumano
  • Naomi Sugimori
  • Shinichiro Mori
  • Yoshitada Takemoto
  • Shigeru Shimadoi
  • Jun Ozaki
  • Yoichi Takaue
  • Shinji Nakao
Article

Abstract

To determine whether induction of graft-versus-host disease (GVHD) improves the outcome of acute relapsed leukemia after stem cell transplantation (SCT), we used high-dose cytarabine (ara-C) followed by infusions of donor-derived buffy coats containing peripheral blood stem cells to treat 12 patients with relapsed leukemia. Donor lymphocyte infusion (DLI) was repeated at least twice over a 5-week interval for patients in whom grade II to IV acute GVHD did not develop after the first DLI. Grade II to IV acute GVHD developed in 4 (33%) of the patients. Chronic GVHD developed in 3 patients, 2 of whom had not experienced acute GVHD. Four (67%) of the 6 patients who developed grade II to IV acute and/or chronic GVHD after DLI responded, but none of the other 6 patients responded. Four (33%) of the patients (2 with acute myelogenous leukemia [AML]and 2 with acute lymphoblastic leukemia [ALL]) achieved complete remission lasting longer than 4 months after the first DLI, but 3 of them had relapses in bone sites. Of these 4 patients, 1 patient with AML and 2 with ALL were alive 8 to 27 months after DLI. These findings indicate that high-dose ara-C combined with megadose DLI may produce durable remission of acute leukemia that has relapsed after SCT when GVHD is induced. The low induction rate of GVHD and extramedullary relapse after remission is achieved with DLI are problems yet to be solved.

Key words

Megadose donor lymphocyte infusion Peripheral blood stem cells Graft-versus-leukemia effect High-dose ara-C Acute leukemia relapse 

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Copyright information

© The Japanese Society of Hematology 2005

Authors and Affiliations

  • Akiyoshi Takami
    • 1
  • Hirokazu Okumura
    • 1
  • Hirohito Yamazaki
    • 1
  • Masahiro Kami
    • 2
  • Song-Wong Kim
    • 2
  • Hidesaku Asakura
    • 1
  • Tomoyuki Endo
    • 3
  • Mitsuyuki Nishio
    • 3
  • Koichiro Minauchi
    • 3
  • Koki Kumano
    • 3
  • Naomi Sugimori
    • 1
  • Shinichiro Mori
    • 2
  • Yoshitada Takemoto
    • 4
  • Shigeru Shimadoi
    • 1
  • Jun Ozaki
    • 1
  • Yoichi Takaue
    • 2
  • Shinji Nakao
    • 1
  1. 1.Department of Cellular Transplantation BiologyKanazawa University Graduate School of MedicineIshikawaJapan
  2. 2.Hematopoietic Stem Cell Transplantation UnitNational Cancer Center HospitalTokyo
  3. 3.Second Department of MedicineHokkaido University Graduate School of MedicineSapporo
  4. 4.Department of HematologyImamura Bun-in HospitalKagoshimaJapan

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