autologous blood and marrow transplantation - Blog Science ...

Immunotherapy With IL-2
After Autologous Stem Cell Transplant
for Acute Myelogenous Leukemia in First Remission
Anthony 5. Stein, Marilyn L Slovak, Irena Sniecinski, Doni Woo
Andrew Dagis, Nayana Vora, Daniel Arber, Stephen J. Forman
Department of Hematology and Bone Marrow Transplantation
(A.S.S., D.W., SJ.F.), Department of Cytogenetics (M.L.S.),
Department of Transfusion Medicine (I.S.), Division of Information Sciences
(A.D.), Division of Radiation Oncology (N.V.), and Department of Anatomic
Pathology (DA.), City of Hope National Medical Center, Duarte, CA
ABSTRACT
Despite improvement in the proportion of patients achieving durable remission
with dose-intensive consolidation strategies, leukemic relapse still occurs in
40—70% of patients who achieve remission. Interleukin (IL)-2 is a cytokine that has
a broad range of antitumor effects and has been used in some patients undergoing
autologous transplant for a variety of malignancies. We have conducted a study to
determine the toxicity and efficacy of high-dose consolidation followed by stem
cell collection and the use of a radiation-based transplant regimen followed by
intensive IL-2 therapy in a phase II trial of 54 patients who had achieved first
remission of their disease. The treatment consisted of consolidation postinduction
with high-dose cytosine arabinoside (Ara-C) with or without idarubicin followed
by peripheral blood stem cell collection. This was followed by autologous
transplant using FTBI 12 g, VP-16 60 mg/kg, Cytoxan 75 mg/kg, and IL-2 on
hematologic recovery. The IL-2 schedule was 9X10 6
IU/m 2
for 24 hours days 1^4
and 1.6X 10 6
IU/m 2
for 24 hours days 9-18. Eight patients were unable to proceed
to transplant because of either toxicity from consolidation or inadequate stem cell
collection. Forty-six patients underwent transplant at a median of 4 months after
complete remission. There was one septic death during neutropenia in consoli­
dation and one during neutropenia for transplant for an overall mortality of the
program of 4%. Thirty-five of 46 patients were able to receive posttransplant IL-2
at a median of 36 days after transplant. With a median follow-up of 25 months
(1.2-47) the 2-year probability for all 54 patients is 75% (95% confidence interval
[CI] 62-86%) and 83% (95% CI 69-92%) for the 46 patients undergoing ASCT.
Toxicities from IL-2 were mainly thrombocytopenia, leukopenia, fluid retention,
46