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Blood, 15 May 2008, Vol. 111, No. 10, pp. 5252-5255.
Prepublished online as a Blood First Edition Paper on March 31, 2008; DOI 10.1182/blood-2007-10-118141.

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TRANSPLANTATION

Brief Report

Complete molecular responses are achieved after reduced intensity stem cell transplantation and donor lymphocyte infusion in chronic myeloid leukemia

Nicholas B. Heaney*,1, Mhairi Copland*,1, Karen Stewart1, Judith Godden1, Anne N. Parker2, I. Grant McQuaker2, Graeme M. Smith3, Charles Crawley4, Pat Shepherd5, and Tessa L. Holyoake1

1 Section of Experimental Haematology and Haemopoietic Stem Cells, University of Glasgow, Glasgow; 2 Department of Haematology, Royal Infirmary, Glasgow; 3 Department of Haematology, Leeds General Infirmary, Leeds; 4 Clinical Haematology, Addenbrookes Hospital, Cambridge; and 5 Western General Hospital, Edinburgh, United Kingdom

Patients with newly diagnosed chronic phase chronic myeloid leukemia were treated with imatinib mesylate (IM) for 6 to 12 months to establish disease control, before reduced intensity stem cell transplantation (RISCT). Escalating doses of donor lymphocyte infusions were given from 6 months after transplantation to eradicate residual disease. A total of 18 patients entered the study and 15 received RISCT (median follow-up, 31 months). RISCT was well tolerated with rapid engraftment, short inpatient stays, and few readmissions. Viral reactivation was common, although extensive graft-versus-host disease occurred infrequently. Donor lymphocyte infusions were given as part of the RISCT protocol in 13 of 15 patients. BCR-ABL transcripts continued to decrease after RISCT, and 8 (53%) patients achieved sustained undetectable levels. All patients are currently off IM. Although IM is now established as first-line therapy for chronic phase chronic myeloid leukemia, this protocol is a safe, well-tolerated, and effective strategy in these patients. This study is registered at http://www.controlled-trials.com as ISRCTN86187144 [controlled-trials.com] .


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