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Complete remission following donor leukocyte infusion in ALL relapsing after haploidentical bone marrow
A Ferster1, W Bujan, T Mouraux
1Hematology/Oncology Unit, Hôpital Universitaire des Enfants, Brussels, Belgium.
Insights
Donor leukocyte infusions (DLI) achieved a second complete remission (CR) in a high-risk infant with acute lymphoblastic leukemia (ALL) after haploidentical bone marrow transplant (BMT). This approach showed acceptable toxicity and reversed relapse, offering hope for similar pediatric cases.
Area of Science:
- Pediatric Oncology
- Hematology
- Immunotherapy
Background:
- High-risk acute lymphoblastic leukemia (ALL) in infants presents significant therapeutic challenges.
- Haploidentical bone marrow transplantation (BMT) is a potential curative option for pediatric ALL.
- Relapse after BMT, especially in high-risk cases, necessitates novel treatment strategies.
Observation:
- A 7-month-old infant with high-risk ALL (translocation 4;11) underwent haploidentical BMT.
- Relapse occurred 11 months post-BMT, prompting treatment with donor leukocyte infusions (DLI).
- The patient achieved a second complete remission (CR) following DLI.
Findings:
- DLI induced a second CR in a pediatric ALL patient with a high-risk genetic translocation.
- Adverse events, including graft-versus-host disease (GVHD) and pancytopenia, occurred post-DLI but were successfully managed.
- The patient remained in CR for six months post-DLI without GVHD or steroid therapy.
Implications:
- DLI can be an effective salvage therapy for relapsed pediatric ALL post-haploidentical BMT.
- This approach offers a potential strategy for achieving durable remission in very high-risk pediatric leukemia.
- Further investigation is warranted to optimize DLI protocols in this vulnerable patient population.
Abstract:
A 7-month-old boy with a high risk ALL harbouring the translocation (4;11) was grafted with an haploidentical bone marrow from paternal origin. At time of relapse, 11 months after BMT, he received donor leukocyte infusions (DLI) which put him in second CR. GVHD and pancytopenia occurred 2 weeks after DLI and were fully reversed with CsA + prednisolone. Six months later, the child continues to be in second CR, off steroid therapy, without any signs of GVHD. Our limited experience indicates that a second CR can be obtained with acceptable toxicity by DLI in very high risk ALL children who have been previously grafted with haploidentical bone marrow cells.