INTENSIVE CHEMOTHERAPY FOLLOWED BY DONOR PBSC IN ANLL RELAPSED AFTER ALLOGENEIC BMT

We describe a 42-year-old man with ANLL-M4 in relapse after allogeneic BMT, in whom a new CR was obtained by conventional chemotherapy follo wed by the infusion of his female donor PBSC, At the time of BMT he wa s in CR. Six months later a full hematological relapse occurred and a three drug 5-day regimen was started. Two days after the end of chemot herapy he received donor PBSC collected by two leukaphereses after mob ilization with G-CSF, given subcutaneously at 5 mu g/kg/day for 7 days . The mononuclear PBSC were 4.2 x 10(8)/kg; the CD34 positive cells we re 8.2 x 10(6)/kg and the CFU-GM were 14 x 10(4)/kg. Two days after PB SC infusion the patient received G-CSF at a dose of 5 mu g/kg/day. Hem opoietic recovery occurred promptly on day +13 and Y-FISH revealed 14% of Y-spot positive cells in the marrow, On day +20 hematological and cytogenetic remission was documented. The percentage of recipient cell s decreased from day +36 onwards following the occurrence of a grade I I GVHD, from which the patient recovered 1 week later with oral cyclos porin A and intravenous high-dose steroids, At present (day +200 from relapse) the patient is still in CR with 3% of Y-spot positive cells.