Reduced-intensity stem cell transplantation using allogeneic peripheral blood stem cells from the same donor for relapsed leukemia after bone marrow transplantation

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  • KUROKI Fumiko
    Department of Pediatrics, Yokohama City University School of medicine
  • GOTO Hiroaki
    Department of Pediatrics, Yokohama City University School of medicine
  • YANAGIMACHI Masakatsu
    Department of Pediatrics, Yokohama City University School of medicine
  • KAJIWARA Ryosuke
    Department of Pediatrics, Yokohama City University School of medicine
  • FUJII Hisaki
    Department of Pediatrics, Yokohama City University School of medicine
  • ISAKI Sakurako
    Department of Pediatrics, Yokohama City University School of medicine
  • TAKAHASHI Hiroyuki
    Department of Pediatrics, Yokohama City University School of medicine
  • IKUTA Koichiro
    Department of Pediatrics, Yokohama City University School of medicine
  • YOKOTA Shumpei
    Department of Pediatrics, Yokohama City University School of medicine

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Other Title
  • 骨髄移植後に再発した急性リンパ性白血病に対する同一ドナーからのRISTレジメンによる末梢血幹細胞移植
  • 症例報告 骨髄移植後に再発した急性リンパ性白血病に対する同一ドナーからのRISTレジメンによる末梢血幹細胞移植
  • ショウレイ ホウコク コツズイ イショク ゴ ニ サイハツ シタ キュウセイ リンパセイ ハッケツビョウ ニ タイスル ドウイツ ドナー カラ ノ RIST レジメン ニ ヨル マッショウケツ カンサイボウ イショク

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Abstract

We report the clinical courses of two cases with relapsed acute lymphoblastic leukemia (ALL) after allogeneic bone marrow transplantation (BMT). After reinduction chemotherapy, the patients received reduced-intensity stem cell transplantation using allogeneic peripheral blood stem cells harvested from their previous BMT donors. The conditioning regimen used consisted of fludarabine and melphalan. Graft-versus-host disease (GVHD) prophylaxis was performed with low dose cyclosporin A (CsA, 1 mg/kg/day d.i.v.) on its own. The regimen related toxicity was minimal, and stable engraftment was achieved. Since acute GVHD had not developed by day 30, CsA was stopped abruptly in both cases. After CsA withdrawal, acute GVHD developed, and subsequent chronic GVHD. One of two cases is alive without any relapse of the leukemia 40 months after the peripheral blood stem cell transplantation (PBSCT). In the other case, ALL relapsed 15 months after the PBSCT, however, complete remission was again induced concomitantly with reactivated GVHD. In both these cases, the results suggest that using PBSC as a stem cell source and abrupt cessation of GVHD prophylaxis provided a potent graft-versus-leukemia effect.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 47 (7), 639-644, 2006

    The Japanese Society of Hematology

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