RELAPSE OF PHILADELPHIA-CHROMOSOME-POSITIVE ACUTE LYMPHOBLASTIC-LEUKEMIA AFTER MARROW TRANSPLANTATION - SUSTAINED MOLECULAR REMISSION AFTEREARLY AND DOSE-ESCALATING INFUSION OF DONOR LEUKOCYTES

We present a patient who underwent sibling allogeneic BMT because of r efractory Ph+ve ALL and remained BCR-ABL-positive after marrow graftin g. Haemopoietic precursor cells were predominantly BCR-ABL-negative an d of donor origin. In T cells an exclusively donor genotype was demons trated. Despite donor leucocyte infusion (DLI), 20 weeks after BMT BCR -ABL fusion mRNA increased in semiquantitative polymerase chain reacti on and leukaemic infiltration of the patient's bone marrow was seen. A fter a second course of DLI the patient achieved sustained molecular r emission but he developed severe graft-versus-host disease (GvHD) and died from bacterial sepsis 9 months after DLI.