Discrepancy between serological complete remission and concomitant new bone lytic lesions after infusion of escalating low doses of donor lymphocytesin multiple myeloma: a case report
D. Rondelli et al., Discrepancy between serological complete remission and concomitant new bone lytic lesions after infusion of escalating low doses of donor lymphocytesin multiple myeloma: a case report, BONE MAR TR, 24(6), 1999, pp. 685-687
Citations number
10
Categorie Soggetti
Hematology,"Medical Research Diagnosis & Treatment
A graft-versus-myeloma effect has been previously induced by infusing high
numbers of donor lymphocytes after allogeneic stem cell transplantation in
relapsed/refractory multiple myeloma (MM) patients. A 43-year-old patient w
ith MM refractory to standard chemotherapy and autologous transplantation r
eceived an allogeneic HLA-matched T cell-depleted marrow transplant from hi
s sister after conditioning with single dose total-body irradiation, melpha
lan and cyclophosphamide, Twenty-four months after transplant neither a sig
nificant reduction of serum M protein nor evidence of acute or chronic graf
t-versus-host disease (GVHD) were observed. The patient was then treated wi
th four escalating low doses of donor lymphocyte infusions (DLI) (0.1, 1.0,
5.0 and 5.0 x 10(6) CD3(+) T cells/kg, respectively) over a 13 month perio
d, Following the second infusion a mild liver acute GVHD and a partial, but
transient, response occurred. After the last DLI the patient achieved a co
mplete remission and developed extensive chronic GVHD. However, concomitant
with the disappearance of clonal plasma cells from the marrow and of serum
M protein, two new bone lytic lesions appeared requiring treatment with ra
diotherapy, In conclusion, escalating low doses of DLI may be effective in
MM and may prevent severe acute but not chronic GVHD, However, the efficacy
of DLI in extramedullary MM lesions is still unclear.