THIRD ALLOGENEIC SIBLING TRANSPLANTATION FOR ACUTE MYELOID LEUKEMIA: A CASE REPORT

Abstract

The most frequent therapeutic dilemma after leukemia relapse is allowing any further attempt at leukemia eradication, or whether to offer only palliative treatment. Remission induction for AML re lapsing after HSCT can be achieved in about 40% of patients. We present a case of 34 years female patient with AML FAB /1.12 with no cytogenetic abnormalities diagnosed in April 1998. After two induction chemotherapy cycles (ARA-C 100mg/m) days 1-7 and Doxorubicin 50mg/m' days 1,3,5) and consolidation with one cycle of high dose chemotherapy (ARA-C 2x500 mg/m' days 1-6 and Doxorubicin 50mglm' days 4-6) complete remission was achieved. First allogeneic sibling transplantation was preformed from fresh bone marrow as source of stem cells and Bu-Cy conditioning, followed by conventional GVHD prophylaxis with MTX+ Cyclosporine. After 24 months disease relapse was registered. The patient was treated with induction chemotherapy with two more cycles of DAE regimen followed by second allogeneic transplant from the same donor with peripheral blood progenitors (PBPC). Two years after the second transplant third re lapse was registered. Remission was achieved with L6 chemotherapy regimen with low dose cytarabine and thioguanine. After that, third allogeneic sibling transplantation was performed with Bu-Cy conditioning, PBPC as source and no GVHD prophylaxis. The patient is still +180 days in CR after the third allogeneic transplantation with good quality of life. At the end we can conclude that leukemia relapse after stem cell transplantation still remains a significant cause of treatment failure in patients with acute leukemia. The success of multiple transplants depends very much on the time interval from the first transplantation, the intensity of prior the therapy, the risk of high mortality rate due to increased regimen toxicity (RR1) as well as undelaying disease and patient performance status prior transplantation.