Autologous bone marrow transplantation (ABMT) is a therapeutic option for patients with high risk hematologie al malignancies who lack a compatible donor, or as part of post remission consolidation for patients with standard risk disease. The lack of graft versus leukemia (GVL) effects, which is frequently associated with GVHD, accounts for the higher probability of relapse in those patients as compared to patients receiving allogeneic marrow transplantation. In order to improve the disease free survival following ABMT in Leukemia, we have attempted to introduce post-transplant immunotherapy against residual tumor cells escaping chemoradiotherapy. We have treated 105 patients with ABMT, 24 with ALL, 79 with ANLL and 2 patients with MDS. Fifty six were in 1CR at the time of transplant, 24 in 2CR and the remaining 25% were in advanced stage. Fifty four patients received unmanipulated marrow autograft while 51 patients received marrow purged with either ASTA-Z (n=44) or other methods (n=7). Twenty two patients received conditioning based on total body irradiation while 69 received BU-CY based protocol. Fifty two patients received post transplant immunotherapy for prevention of relapse: fourteen received interferon-cc (Roferon A) (IFN-a) alone or in combination with recombinant interleukin 2 (IL-2) (Getus/Chiron), 8 received HLA matched lymphocytes, 28 received mismatched lymphocytes with IL-2 and 2 received autologous IL-2 activated lymphocytes in an attempt to induce GVL-like effects. The median survival for patients transplanted in 1CR was 34 months, in 2CR - 15.7 months and in advanced disease 8 months and the relapse free survival was 21, 11 and 7 months respectively. The probability to remain in remission at 2 years for patients treated IFN-a and IL-2 was 75%, for those treated with allogeneic lymphocytes - 28% and for patients without any immunotherapy - 33%. We suggest that administration of IFN-a with or without IL-2 may significantly improve survival in patients with acute leukemia undergoing autologous bone marrow transplantation.
|Number of pages||1|
|State||Published - 1998|