INTERFERON-ALPHA AND DONOR BUFFY COAT TRANSFUSIONS FOR TREATMENT OF RELAPSED CHRONIC MYELOID-LEUKEMIA AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION

Eight patients with chronic myeloid leukemia relapse after allogeneic BMT were treated with IFN-alpha and buffy coat transfusions (BC) of th e bone marrow donor. The antileukemic effect of this treatment was dir ectly demonstrated in 4 patients by the disappearance of Philadelphia chromosome-positive metaphases or the loss of detectable BCR-ABL trans cripts by polymerase chain reaction. In 2 patients in whom cytogenetic or polymerase chain reaction analysis was not performed, a change in hemopoietic chimerism with recurrence of donor-type hemopoiesis was de monstrated. Two patients, both treated in advanced stages of hematolog ical relapse after BMT, did not respond. However, severe side effects of the treatment were observed: graft-versus-host disease (GVHD) occur red in 5 patients. Two of these patients progressed to severe chronic GVHD and 1 patient ultimately died of this complication. GVHD occurred in 5 of the 6 responding patients; one patient responded without deve loping clinical symptoms of GVHD. Six patients developed bone marrow h ypoplasia after IFN/BC treatment, and pancytopenia occurred in 4 patie nts. None of these 4 patients recovered spontaneously and 2 patients d ied of complications of pancytopenia (cerebral bleeding, infection). O ur results demonstrate that treatment of chronic myeloid leukemia rela pse with IFN and BC transfusions is highly effective in patients with relapse in chronic phase. The occurrence of GVHD and pancytopenia, how ever, resulted in a high treatment-associated morbidity and mortality. Whereas a response to treatment was observed in 1 patient without GVH D, indicating that GVHD and a graft-versus-leukemia effect may be clin ically separable, bone marrow hypoplasia occurred in all responding pa tients.