CHRONIC MYELOID-LEUKEMIA - MANAGEMENT OF RELAPSE AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION

The management of chronic myeloid leukemia (CML) patients who relapse after allogeneic bone marrow transplantation (BMT) is difficult. Hydro xyurea, alpha interferon, second BMT and leukocytes infusion are vario us options but none of these approaches is clearly optimal. Hydroxyure a controls the symptoms in most patients without any apparent survival benefit. Alpha interferon (IFN) results in haematological remission i n most cases with partial or total Philadelphia negativity in 20-30% o f patients. Whether IFN therapy prolongs survival is not yet certain. Second BMT results in successful outcome in about half of the patients , however toxicity to the preparatory regimen, post transplant venoccl usive disease and acute graft versus host disease are all major compli cations. An interval of less than 6 months between the initial and sec ond BMT is generally associated with a poor outcome. Buffy coat infusi ons from the original donor have resulted in a cytogenetic remission i n most patients. Less intensive preparatory regimes, donor buffy coat infusion and the use of biological response modifiers post transplant in order to augment the graft versus leukemia effect in high risk pati ents may indeed be possible areas of improvement in future studies.