Sustained molecular remission in a patient with CML in blastic crisis receiving dose‐reduced hematopoietic stem‐cell transplantation followed by early withdrawal of cyclosporine and prophylactic use of interferon‐α

• Published in: American journal of hematology Vol. 71; no. 3; pp. 196 - 199
• Main Authors: Hamaki, Tamae, Kami, Masahiro, Momomura, Shin‐ichi, Mineishi, Shin, Kusumi, Eiji, Kanda, Yoshinobu, Ueyama, Jun‐ichi, Miyakoshi, Shigesaburo, Morinaga, Shin‐ichi, Takaue, Yoichi, Mutou, Yoshitomo
• Format: Journal Article
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 01.11.2002; Wiley-Liss
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blast Crisis - surgery; Bone marrow, stem cells transplantation. Graft versus host reaction; chronic myelocytic leukemia; cyclosporine; Cyclosporine - administration & dosage; Cyclosporine - therapeutic use; Drug Administration Schedule; Graft vs Host Disease - physiopathology; Graft vs Host Disease - prevention & control; Hematopoietic Stem Cell Transplantation - methods; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - therapeutic use; Interferon-alpha - therapeutic use; interferon‐α; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - drug therapy; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - pathology; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - surgery; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - prevention & control; reduced‐intensity hematopoietic stem‐cell transplantation; Remission Induction; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; interferon-α; Alpha interferon; Stem cell; Adjuvant treatment; Hematopoietic cell; Homograft; Male; Blast transformation; reduced-intensity hematopoietic stem-cell transplantation; Myeloproliferative syndrome; Immunotherapy; Chronic myelocytic leukemia; Graft; Complication; Evolution; Remission; Human; Graft versus leukemia reaction; cyclosporine; Unrelated donor; Low dose; Malignant hemopathy; Case study; Chronic; Treatment
• ISSN: 0361-8609; 1096-8652
• DOI: 10.1002/ajh.10203

A 54‐year‐old man with chronic myelocytic leukemia in blastic phase received reduced‐intensity transplantation (RIST) from an HLA‐identical unrelated donor. The preparative regimen consisted of busulfan, fludarabine, and anti‐thymocyte globulin. Graft‐versus‐host disease (GVHD) prophylaxis was cyclosporine alone. Because he had a high risk of relapse, we discontinued cyclosporine on day 37, but he did not develop any signs of acute GVHD. To induce GVHD and augment a graft‐versus‐leukemia effect, we initiated interferon‐α therapy on day 80 to a maximum dosage of three million units five times a week. He achieved molecular remission on day 94 followed by the development of extensive chronic GVHD the severity of which paralleled to the dose of interferon‐α GVHD gradually subsided after discontinuation of interferon‐α and the patient remains in molecular remission 18 months after transplantation. This case suggests that early withdrawal of cyclosporine and the prophylactic use of interferon‐α are promising in RIST for high‐risk leukemia. Am. J. Hematol. 71:196–199, 2002. © 2002 Wiley‐Liss, Inc.