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Donor leukocyte infusion for leukemic relapse after allogeneic marrow
transplantation: lack of residual donor hematopoiesis predicts aplasia
F Keil, OA Haas, G Fritsch, P Kalhs, K Lechner, C Mannhalter, E Reiter, D Niederwieser, P Hoecker and HT Greinix
Department of Medicine I, Bone Marrow Transplantation Unit, University of
Vienna, Austria.
We assessed the chimerism of CD34+ bone marrow cells before donor leukocyte
infusion (DLI) on nine occasions in seven patients with leukemic relapse
after allogeneic marrow transplantation. The patients suffered from acute
lymphoblastic leukemia (n = 1), acute myeloid leukemia (n = 3), and chronic
myeloid leukemia (CML; n = 3). Two patients received a second DLI because
of disease progression after the first one. The origin of the CD34+ cells
was determined by analyzing variable number of tandem repeats with
polymerase chain reaction and, in sex-mismatched cases, by fluorescence in
situ hybridization. Before DLI CD34+ cells were exclusively of donor origin
in four patients. In another patient 41% of CD34+ cells were derived from
the donor. No aplasia occurred in these patients after DLI, whereas in the
two patients with exclusively recipient hematopoiesis severe aplasia
lasting for 5 and 13 weeks necessitated hematopoietic stem cell support.
One patient who had only 5% CD34+ donor cells before DLI recovered without
stem cell support after 10 days. Two patients in relapse of CML showed a
high percentage of BCR-ABL- CD34+ cells of recipient origin before DLI.
These BCR-ABL- cells of recipient type did not prevent severe aplasia which
indicates that the assessment of BCR- ABL+ hematopoiesis alone is
insufficient for predicting aplasia. Our data indicate that in case of
sufficient donor hematopoiesis before DLI no persistent aplasia will occur.
Thus, evaluation of donor hematopoiesis allows prediction of aplasia after
DLI and makes early therapeutic interventions possible.
Volume 89,
Issue 9,
pp. 3113-3117,
05/01/1997
Copyright © 1997 by The American Society of Hematology
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