A RETROSPECTIVE SINGLE-CENTER STUDY OF THE OUTCOME OF 5 DIFFERENT THERAPY APPROACHES IN 48 PATIENTS WITH RELAPSE OF CHRONIC MYELOGENOUS LEUKEMIA AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION

In a retrospective single centre study we examined the outcome of five different therapy approaches in 48 patients in whom a relapse of CML (13 cytogenetic relapses, 35 hematological relapses: 10 chronic phase (CP), nine accelerated phase, 16 blast crisis) occurred after allogene ic BMT, Cyclosporin A (CsA) withdrawal, interferon alpha-2b (IFN-alpha ) therapy, donor leukocyte transfusions (DLT), second transplantation (2nd BMT), and chemotherapy (CTX) alone were used and studied for thei r response rates, Patients who achieved a complete hematologic and cyt ogenetic remission (CR) were studied for BCR-ABL transcripts and for t heir chimerism status by PCR, A strong antileukemic effect was observe d after abrupt CsA withdrawal, with 10 of 20 patients achieving a CR ( 50%), All 10 patients with early stage (nine cytogenetic and one CP), but none of the patients with advanced disease recurrence, responded t o CsA withdrawal, IFN-alpha induced in five of 11 patients (45%) a sta ble cytogenetic remission, whereas treatment with DLT induced a CR in only two of 14 patients (14%), A second transplant was performed in si x patients, Three of six patients (50%) survive disease-free at a medi an of 19 months after the 2nd BMT (range 10-25), The use of CTX alone did not induce a remission.