PRELIMINARY-RESULTS OF TREATMENT WITH FILGRASTIM FOR RELAPSE OF LEUKEMIA AND MYELODYSPLASIA AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION

Background. Patients whose leukemia relapses after allogeneic bone mar row transplantation have a poor prognosis; few respond to further chem otherapy, and almost none survive over the long term. We present preli minary observations on the use of filgrastim (granulocyte colony-stimu lating factor) for relapse after transplantation. Methods. Seven femal e patients with leukemia (one with chronic myelogenous leukemia, five with acute myelogenous leukemia, and one with a myelodysplastic syndro me that transformed into.acute myelogenous leukemia) whose disease rel apsed within 360 days after allogeneic bone marrow transplantation rec eived filgrastim (5 mug per kilogram of body weight per day by subcuta neous injection) to reinduce remission by stimulating residual donor m arrow cells. Cytogenetic analysis of bone marrow, fluorescence in situ hybridization, and determination of restriction-fragment-length polym orphisms were used to assess response and chimerism. Results. Three of the seven patients had a complete hematologic and cytogenetic remissi on, with reestablishment of hematopoiesis of donor origin. Mild chroni c graft-versus-host disease developed in one patient, and acute graft- versus-host disease in none. One patient had a relapse 12 months after treatment, and two others remained in remission after 10 and 11 month s. In two of the patients with a response, fluorescence in situ hybrid ization demonstrated stimulation of donor cells without differentiatio n of the leukemic clone. Conclusions. Filgrastim may be effective in s elected cases of leukemic relapse after allogeneic bone marrow transpl antation.