ALLOGENEIC PERIPHERAL-BLOOD STEM-CELL TRANSPLANTATION FOR TREATMENT OF INDUCTION FAILURE IN A PATIENT WITH PHILADELPHIA-CHROMOSOME-POSITIVEACUTE LYMPHOBLASTIC-LEUKEMIA

We report a successful case of allogeneic peripheral blood stem cell t ransplantation (PBSCT) for the treatment of primary induction failure in acute lymphoblastic leukemia (ALL). The patient was a 46-year-old m ale with Ph-positive ALL and failed to achieve complete remission (CR) , His HLA genotypically identical brother refused to donate bone marro w. Instead, PBSCs were collected by apheresis from the brother after a dministration of G-CSF at a dose of 10 mu g/kg. For allogeneic PBSCT, the patient was conditioned with marrow ablative chemotherapy and rece ived the PBSC harvest containing 7.8 x 10(4)/kg of CFU-GM, 1.8 x 10(6) /kg of CD34-positive cells and 2.7 x 10(8)/kg of T lymphocytes, After transplant, the neutrophil count exceeded 0.5 x 10(9)/l on day 16 and the platelet count exceeded 20 x 10(9)/l on day 22. CR was confirmed w ith tri-lineage engraftment in bone marrow samples on days 28 and 49; disappearance of the Ph-chromosome was documented. Sustained engraftme nt was also confirmed cytogenetically using a variable number of tande m repeat (VNTR) markers. Acute graft-vs.-host disease did not develop with conventional prophylaxis of methotrexate and cyclosporine. Howeve r, on day 85 the patient developed leukemia relapse and died on day 97 . This clinical trial suggests that allogeneic PBSCT may be an alterna tive to allogeneic bone marrow transplantation in some limited situati ons.