ADOPTIVE IMMUNOTHERAPY WITH DONOR MONONUCLEAR CELL INFUSIONS TO TREATRELAPSE OF ACUTE-LEUKEMIA OR MYELODYSPLASIA AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION

Relapse remains a significant problem after allogeneic bone marrow tra nsplantation (BMT). For patients with relapsed chronic myelogenous leu kemia (CML), infusions of donor mononuclear cells (MNC) provide a pote nt graft-versus-leukemia (GVL) reaction inducing complete remissions i n the majority of patients, Little is known about the efficacy of dono r MNC infusions for patients who relapse with other diseases, We have studied the GVL effects of donor MNC in eight patients with relapsed a cute leukemia or myelodysplasia (MDS). One patient with relapsed MDS a chieved complete remission and another patient had a transient respons e, Five of six non-responders died of progressive leukemia and one non -responder died of complications during second BMT. Three patients dev eloped grade I-II acute GVHD responsive to immunosuppression, These da ta, and review of the literature, suggest that GVL induction with dono r MNC infusions is less effective for patients with relapsed acute leu kemia than for patients with relapsed CML; too few patients with relap sed MDS have been treated to draw definite conclusions, However, some patients respond, and given the high mortality associated with alterna tive procedures such as second BMT, donor MNC infusions are a reasonab le approach for relapsed acute leukemia and MDS after allogeneic BMT.