Submitted October 29, 2007
Accepted March 8, 2008
Complete molecular responses are achieved following reduced intensity stem cell transplantation and donor lymphocyte infusion in chronic myeloid leukaemia
Nicholas B. Heaney, Mhairi Copland, Karen Stewart, Judith Godden, Anne N. Parker, I. Grant McQuaker, Graeme M. Smith, Charles Crawley, Pat Shepherd, and Tessa L. Holyoake*
Section of Experimental Haematology & Haemopoietic Stem Cells, University of Glasgow, Glasgow, United Kingdom
Department of Haematology, Royal Infirmary, Glasgow, United Kingdom
Department of Haematology, Leeds General Infirmary, Leeds, United Kingdom
Clinical Haematology, Addenbrookes Hospital, Leeds, United Kingdom
Western General Hospital, Edinburgh, United Kingdom
* Corresponding author; email: tlh1g{at}clinmed.gla.ac.uk.
Patients with newly diagnosed chronic phase chronic myeloid leukaemia (CML) were treated with imatinib mesylate (IM), for 6-12 months to establish disease control, prior to reduced intensity stem cell transplantation (RISCT). Escalating doses of donor lymphocyte infusions (DLI) were given from 6 months post-transplant to eradicate residual disease. 18 patients entered the study and 15 received RISCT (median follow up 31 months). RISCT was well tolerated with rapid engraftment, short in-patient stays and few readmissions. Viral reactivation was common, although extensive graft versus host disease (GvHD) occurred infrequently. DLI were given as part of the RISCT protocol in 13/15 patients. BCR-ABL transcripts continue to decrease post-RISCT and 8 (53%) patients have achieved sustained undetectable levels. All patients are currently off IM. Although IM is now established as first-line therapy for chronic phase CML, 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.
