Graft-versus-leukemia-induced complete remission following unrelated umbilical cord blood transplantation for acute leukemia.

Journal Article

A 15-year-old female received an unrelated three of six HLA antigen matched umbilical cord blood (UCB) transplant for refractory, relapsed T-cell ALL. Conditioning consisted of TBI, melphalan, and anti-thymocyte globulin (ATG), with cyclosporin A (CsA) and solumedrol for GVHD prophylaxis. She engrafted and a day 34 bone marrow aspirate showed 100% donor cells and no evidence of leukemia. The post-transplant course was complicated by mild grade I acute GVHD involving skin, and limited chronic GVHD of the gut which resolved with the addition of 1 mg/kg/day of steroids to her CsA prophylaxis. One hundred and ninety days after transplantation the patient developed pancytopenia and was subsequently found to have a leukemic relapse. Immunosuppression was discontinued and she was started on G-CSF and erythropoietin. Moderate skin and gut GVHD developed which was treated with both topical and low-dose oral steroids. Over the next few weeks she became transfusion independent and a follow-up bone marrow aspirate showed complete remission. She continued in complete remission for 4 months, at which time localized leukemic relapse was found in a soft tissue breast mass in spite of continued bone marrow remission. While the patient ultimately died of progressive disease, this case demonstrates that mismatched UCB in conjunction with G-CSF is capable of generating a GVL effect that can induce a complete remission.

Full Text

Duke Authors

Cited Authors

  • Howrey, RP; Martin, PL; Driscoll, T; Szabolcs, P; Kelly, T; Shpall, EJ; Bearman, SI; Slat-Vasquez, V; Rubinstein, P; Stevens, CE; Kurtzberg, J

Published Date

  • December 2000

Published In

Volume / Issue

  • 26 / 11

Start / End Page

  • 1251 - 1254

PubMed ID

  • 11149743

International Standard Serial Number (ISSN)

  • 0268-3369

Digital Object Identifier (DOI)

  • 10.1038/sj.bmt.1702697

Language

  • eng

Conference Location

  • England