Treatment of leukemic relapse after allogeneic stem cell transplantation with cytotoreductive chemotherapy and/or immunotherapy or second transplants

We analyzed toxicity and efficacy of chemotherapy (CT) or second stem cell transplantation (SCT) and/or immunotherapy defined as stop of immunosuppres sion (IS) or donor leukocyte infusion (DLI) in 47 patients relapsing with a cute leukemia. Ten patients received no treatment and 14 patients were trea ted with CT only. In 12 patients IS was stopped and three of them received additional CT. Five patients received DLI after CT as consolidation and one patient as frontline therapy. Five patients received a second SCT, Median overall survival after relapse was 2 months for the untreated patients, 2 m onths for patients receiving CT only, 2 months in patients after cessation of IS, 17 months in DLI treated patients and three months in patients recei ving a second SCT, Fourteen patients achieved remission after relapse. Two with CT (2, 2 months), three with Si (3, 19, 19+ months), six with DLI (3, 8, 9, 14, 20, 36 months) and three with second SCT (2, 4, 6 months). Conven tional CT was able do re-establish donor hematopoiesis and patients achievi ng remission showed a significantly better survival than patients with refr actory disease. Patients who were brought into remission by DLI or cessatio n of IS had a significantly better survival than patients who achieved remi ssion with CT alone or a second SCT, We conclude that a selected group of p atients achieving remission with regeneration of donor hematopoiesis follow ing CT might benefit from immunotherapy as consolidation.