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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

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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.

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Authors and Affiliations

  1. Department of Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, 13-1 Takaramachi, Kanazawa, 920-8641, Ishikawa, Japan

    Akiyoshi Takami, Hirokazu Okumura, Hirohito Yamazaki, Hidesaku Asakura, Naomi Sugimori, Shigeru Shimadoi, Jun Ozaki & Shinji Nakao

  2. Hematopoietic Stem Cell Transplantation Unit, National Cancer Center Hospital, Tokyo

    Masahiro Kami, Song-Wong Kim, Shinichiro Mori & Yoichi Takaue

  3. Second Department of Medicine, Hokkaido University Graduate School of Medicine, Sapporo

    Tomoyuki Endo, Mitsuyuki Nishio, Koichiro Minauchi & Koki Kumano

  4. Department of Hematology, Imamura Bun-in Hospital, Kagoshima, Japan

    Yoshitada Takemoto

Authors
  1. Akiyoshi Takami
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  2. Hirokazu Okumura
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  3. Hirohito Yamazaki
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  4. Masahiro Kami
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  5. Song-Wong Kim
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  6. Hidesaku Asakura
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  7. Tomoyuki Endo
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  8. Mitsuyuki Nishio
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  9. Koichiro Minauchi
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  10. Koki Kumano
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  11. Naomi Sugimori
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  12. Shinichiro Mori
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  13. Yoshitada Takemoto
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  14. Shigeru Shimadoi
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  15. Jun Ozaki
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  16. Yoichi Takaue
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  17. Shinji Nakao
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Corresponding author

Correspondence to Shinji Nakao.

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Takami, A., Okumura, H., Yamazaki, H. et al. 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. Int J Hematol 82, 449–455 (2005). https://doi.org/10.1532/IJH97.05086

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  • DOI: https://doi.org/10.1532/IJH97.05086

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