[Donor peripheral blood mononuclear cell infusion (DMNCI) for treatment of patients with relapsed leukemia after haploidentical bone marrow transplantation].

Abstract

This study was aimed to investigate the therapeutic effect of growth factor-primed donor peripheral mononuclear stem cell infusion (DMNCI) for patients with relapsed leukemia after haploidentical bone marrow transplantation (BMT). The donor was the same individual for both BMT and DMNCI. All the three patients described here were Philadelphia chromosome positive leukemia before haploidentical BMT; one case was newly diagnosed as acute lymhoblastic leukemia (ALL) and the others were chronic myeloid leukemia (CML). Two cases (one with ALL and one with CML) manifested with clinical relapse and the third case was in the stage of molecular relapse. The former 2 patients received a single bulk dose of DMNCI, the inoculums of which contained mononuclear cells of 8.25 x 10(8)/kg or 5.24 x 10(8)/kg and CD3-positive cells of 1.87 x 10(8)/kg or 1.14 x 10(8)/kg respectively. The third case received initial dose of DMNCI which was 2.0 x 10(7)/kg, and received CD3 positive cells of 1.1 x 10(7)/kg. The results indicated that the different therapeutic responses were found in all three patients. Two patients with clinical relapse received temporal remission, and died of severe graft versus host disease (GVHD), relapse and failure at day 41 and 49 after DMNCI. The third patient with molecular relapse received molecular remission after 2 infusions of DMNCI. All three patients developed acute GVHD, but two patients among them developed GVHD of grad IV, other one developed GVHD of grad I and has survived in disease-free state during half a year follow-up. It is concluded that the DMNCI may be effective for the treatment of relapsed leukemia after haploidentical BMT and this treatment can be safe if the initial dose of DMNCI is 10(7)/kg and subsequent single dose of DMNCI gradually increases.