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Suttorp (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 12
doi: 10.3205/ctt-2011-No12-abstract77

© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "5th Raisa Gorbacheva Memorial Meeting Hematopoietic Stem Cell Transplantation in Children and Adults", Saint Petersburg, Russia, September 18–20, 2011

Preliminary Program

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Treatment of imminent relapse by donor lymphocyte infusions or tyrosine kinase inhibitors after stem cell transplantation for chronic myeloid leukemia

Meinolf Suttorp

Pediatric Hematology, Oncology, and Stem Cell Transplantation, University Hospital "Carl Gustav Carus", Dresden, Germany

Correspondence: Prof. Dr. med. Meinolf Suttorp, Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, University Hospital “Carl Gustav Carus”, Fetscherstr. 74, D-01307, Dresden, Germany, E-mail: meinolf.suttorp@spam is baduniklinikum-dresden.de

Abstract

Donor leukocyte infusions (DLI) have become an established treatment option (Kolb HJ et al., Blood 1995) for relapse of chronic myeloid leukemia (CML) post stem cell transplantation (SCT). The introduction of tyrosine kinase inhibitors (TKI) such as imatinib (IMA) has not only postponed SCT as a 2nd line treatment for CML, but also broadened the spectrum of post-SCT interventional strategies for relapse. Notably, the CML relapse rate after SCT has increased, as in most countries today more than 50% of all SCTs are performed either in advanced stages of CML or after TKI-failure. Thus, post-SCT monitoring and strategies for prophylactic or therapeutic intervention in the case of relapse are of great importance in these selected patients (pat).

Data from studies are still limited, but the safety of IMA also when administered early after SCT is acceptable. The combination of IMA with DLI does not result in increased toxicity or graft-versus-host disease (GvHD). This also seems to hold true in studies with 2nd generation TKIs. The optimal strategy for DLI administration with respect to i) timing post SCT; ii) the kinetics of the BCR-ABL transcript rate; iii) whether a course of TKI treatment or iv) cytotoxic conditioning should be administered prior to DLI; v) the escalation schedule of DLI cell dose; vi) if DLI plus CD34+ cells should be administered, still remains unclear. DLI may lead to disease-free survival in >60% of all pat. with CML relapse and approach 90% in pat. with only molecular relapse. However, as more than 30% of the pat. will develop acute and/or chronic GVHD after DLI, treatment-related mortality is 5–20%. Thus, TKIs are promising options to treat CML relapse after SCT, but clinical algorithms for a combined use with DLI still have to be developed.

Keywords: CML relapse, stem cell transplantation, tyrosine kinase inhibitors, donor lymphocyte infusions