PMID- 20168246
OWN - NLM
STAT- MEDLINE
DCOM- 20100330
LR  - 20111006
IS  - 1536-3678 (Electronic)
IS  - 1077-4114 (Linking)
VI  - 32
IP  - 2
DP  - 2010 Mar
TI  - Graft-versus-leukemia effect on infant lymphoblastic leukemia relapsed after 
      sibling hematopoietic stem cell transplantation.
PG  - e57-60
LID - 10.1097/MPH.0b013e3181c6beef [doi]
AB  - INTRODUCTION: Infant acute lymphoblastic leukemia (ALL) is considered a high-risk 
      entity. Patients diagnosed in the first 3 months of life have especially high 
      mortality. By morphology, infant ALL is classified as a lymphoid lineage 
      leukemia; however, its physiologic behavior has brought many to consider it a 
      pathologic hybrid between lymphoid leukemia and myeloid leukemias. As such, 
      standard of care currently employs the use of chemotherapeutic agents used 
      commonly in ALL protocols and agents typically reserved for the treatment of 
      myelogenous lineage leukemias. The role of hematopoietic stem cell 
      transplantation and graft-versus-leukemia effect in these patients has not been 
      well studied. CASE PRESENTATION: An earlier healthy 9-week-old Hispanic male 
      diagnosed with precursor B-cell lymphoblastic leukemia was treated with protocol 
      P9407 and matched sibling hematopoietic stem cell transplantation. Relapse was 
      noted on posttransplant day +114 with blasts on peripheral blood smear. The sole 
      antigraft-versus-host disease (GVHD) agent, cyclosporine, was discontinued. Blast 
      clearance from the peripheral blood was obtained by posttransplant day +128 with 
      the appearance of skin and liver GVHD at posttransplant day +181. Bone marrow 
      examination on posttransplant day +205 revealed normal marrow with no evidence of 
      leukemic cells. He remains disease free more than 2 years posttransplant. 
      CONCLUSION: Traditionally, graft-versus-leukemia effect was thought to contribute 
      therapeutically little to the treatment of ALL by hematopoietic stem cell 
      transplantation (HSCT). The effects of graft-versus-leukemia immunologic 
      phenomenon in our patient with infant acute lymphoblastic leukemia underscore the 
      potential that infant ALL may not be entirely the same biologic entity as 
      standard pediatric ALL and may be more responsive than understood earlier. 
      Therapeutic response and appearance of GVHD after the withdrawal of 
      immunosuppression in this patient provides evidence that graft-versus-leukemia 
      effect may play a role in disease control in infant ALL after HSCT. Patients who 
      relapse after the HSCT may be salvaged with the withdrawal of immunosuppression. 
      This suggests that other immunotherapeutic interventions in the context of 
      relapse may offer potential clinical benefit in this disease.
FAU - Boatsman, Erin E
AU  - Boatsman EE
AD  - Division of Pediatric Hematology/Oncology, David Geffen School of Medicine/Mattel 
      Children's Hospital UCLA, Los Angeles, CA, USA. Erin.E.Boatsman@kp.org
FAU - Fu, Cecilia H
AU  - Fu CH
FAU - Song, Sophie X
AU  - Song SX
FAU - Moore, Theodore B
AU  - Moore TB
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - J Pediatr Hematol Oncol
JT  - Journal of pediatric hematology/oncology
JID - 9505928
SB  - IM
MH  - *Graft vs Leukemia Effect
MH  - *Hematopoietic Stem Cell Transplantation
MH  - Humans
MH  - Infant
MH  - Male
MH  - Precursor Cell Lymphoblastic Leukemia-Lymphoma/*therapy
MH  - Recurrence
MH  - Transplantation, Homologous
EDAT- 2010/02/20 06:00
MHDA- 2010/03/31 06:00
CRDT- 2010/02/20 06:00
PHST- 2010/02/20 06:00 [entrez]
PHST- 2010/02/20 06:00 [pubmed]
PHST- 2010/03/31 06:00 [medline]
AID - 10.1097/MPH.0b013e3181c6beef [doi]
PST - ppublish
SO  - J Pediatr Hematol Oncol. 2010 Mar;32(2):e57-60. doi: 
      10.1097/MPH.0b013e3181c6beef.