Klin Onkol 2000; 13(5): 159-166.
Abstract: Efficacyd a protocol of adoptive immunotherapy using IL-2 activated autologous graft followed with IL-2 and GM-CSF immunotherapy was investigated. Interleukin 2 (IL-2) can generate non-specific cytotoxic effectors like Natural Killer (NK) cells. Protocol was activated in patients with chronic myeloid leukemia, in which treatment response can be monitored on molecular level and immunotherapy plays fundamental role in the treatment.
Methods and Patients: 8 patients (pts.) with late chronic phase (CP) or accelerated phase (AP) of CML received IL-2 activated graft. Mini ICE (idarubicin, Ara-C, etoposid) was used before PBSC collection, busulphan 12-16 mg/m2 was used as myeloablative regimen. One-month immunotherapy (IL-2 0,5 x 106 IU/m2/day/s.c/days 2-28; GM-CSF 75?g /m2/day/s.c/days 7-28) was followed 6-months interferon alpha therapy (3x3MU/wk).3 pts. received IL-2 activated back-up only due to insufficient PBSC collection.
Results: Early transplant related mortality was 0 % (0/5), collection of autologous graft was successful in 71 % pts., median of the time to graft collection was 22,0 days (19-25), neutrophil engraftment occurred on day 15 (median) (range 11-18) in 4 pats. One pt. required back-up infusion with engraftment on day +95. Toxicity of chemotherapy (mini-ICE, busulphan) was acceptable; toxicity of immunotherapy was minimal. 5 of 8 patients improved their disease (from AP to CP), two cytogenetic responses (1/1; major/minor) were observed.
Conclusion: Autologous transplantation followed with low dose immunotherapy had acceptable toxicity and stabilized disease in chronic phase in patients with late chronic phase or accelerated phase of CML. Engraftment and graft collection could be problems in these patients. Based on these results we can not decide if more important for improvement of patients is responsible transplantation procedure or immunotherapy.
