Effect of induced GVHD in leukemia patients relapsing after allogeneic bone marrow transplantation: single-center experience of 33 adult patients

Bone Marrow Transplant. 2001 May;27(9):999-1005. doi: 10.1038/sj.bmt.1703021.

Abstract

In a retrospective single center study, we examined the outcome of induced GVHD in leukemia patients relapsing after allogeneic BMT. Thirty-three adult patients with leukemia (15 AML, 3 ALL, and 15 CML) persisting or relapsing 1-36 months (median, 6) after allogeneic BMT underwent various immune manipulations and consequently developed acute and/or chronic GVHD at our center. Immunotherapies to elicit GVHD comprised chemotherapy followed by PBSC (n = 18), non-myeloablative transplant (n = 2), PBL followed by IFN-alpha (n = 5), PBL alone (n = 3), abrupt cessation of CsA (n = 3), and CsA withdrawal combined with IFN-alpha (n = 2). Twenty-four (72.7%) patients obtained a remission including complete hematological or cytogenetic remission, respectively, for acute leukemias or CML. Overall survival of patients, estimated at 3 years using the Kaplan-Meier method, was 33.9% (95% CI, 20-52%). Twelve patients including two patients with ALL remain in complete hematological (n = 5) or cytogenetic remission (n = 7) 3-93 months (median 12) after achieving remission. Twelve (63.2%) of 19 dead patients died due to treatment-related toxicities; five patients from acute GVHD, three from GVHD followed by infections and four from infections. By multivariate Cox analysis, only chronic GVHD resulted in a higher probability of disease-free survival (P = 0.026). Eight patients who had both acute GVHD < or = grade I and chronic GVHD are all alive without leukemia. We conclude that acute GVHD is associated with considerable toxicity while chronic GVHD plays a role in retaining remission in leukemia relapsing after allogeneic BMT.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / toxicity
  • Bone Marrow Transplantation / adverse effects*
  • Bone Marrow Transplantation / methods
  • Bone Marrow Transplantation / mortality
  • Cyclosporine / administration & dosage
  • Cyclosporine / toxicity
  • Female
  • Graft vs Host Disease / etiology*
  • Graft vs Host Disease / mortality
  • Graft vs Leukemia Effect
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Hematopoietic Stem Cell Transplantation / methods
  • Hematopoietic Stem Cell Transplantation / mortality
  • Humans
  • Immunotherapy / adverse effects
  • Interferon-alpha / administration & dosage
  • Interferon-alpha / toxicity
  • Leukemia / complications
  • Leukemia / mortality
  • Leukemia / therapy*
  • Leukocyte Transfusion / adverse effects
  • Male
  • Recurrence
  • Remission Induction
  • Retrospective Studies
  • Survival Rate
  • Transplantation, Homologous / adverse effects
  • Transplantation, Homologous / mortality

Substances

  • Antineoplastic Agents
  • Interferon-alpha
  • Cyclosporine