Posttransplant relapses

In the event of relapse after allogeneic bone marrow transplantation, donor lymphocyte infusions have resulted in obliteration of the malignant clone with long-lasting hematological and cytogenetic remissions. In the largest series, 72% of 75 evaluable patients were reported to achieve a complete cytogenetic response following post-transplant relapse, and the 3-year survival after donor lymphocyte infusions was

67%. Disease stage at relapse is fundamental to the prediction of outcome. When relapse is detected by cytogenetic analysis or molecular analysis, donor lymphocyte infusion is typically effective, while patients with hematological relapse are less likely to respond. Donor lymphocyte infusion is believed to work via immune modulation, in which the donor T cells induce a graft-versus-leukemia effect that allows the normal cells to re-expand as the malignant clone is destroyed. Acute GVHD and myelosuppression complicate this procedure and are associated with a 1-year mortality of 18%. These complications may be reduced by adjusting the dose and the subsets of lymphocytes infused.

Imatinib has also shown significant activity in patients who relapse after transplantation. However, there are insufficient data to determine whether imatinib or donor lymphocyte infusions should be the preferred therapy for this patient population.

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