Treatment options will depend on the particular circumstances for each person, including their original diagnosis. However, there are several different types of treatment that may be available. For patients with CML and some other diseases, donor lymphocyte infusion (DLI) can be used to induce a graft-vs.-leukemia or graft-vs.-tumor effect while minimizing the risk of gravt-vs.-host disease (GVHD). Drug therapies include Gleevec and interferon. These medications have been effective for treating CML in relapse with minimal disease, but treatment must be continued indefinitely in order to keep the disease under control. For patients with other diseases, a second transplant might offer the best chance of long-term survival. However, results after a second transplant are not as good as with a first transplant, and a second transplant is not always possible. Additional courses of chemotherapy, radiation therapy or other treatments are also used in some situations. If you have a relapse after a transplant, you should discuss treatment options with your physician. The LTFU would be happy to provide assistance in assessing treatment options. See contact information to get in touch with LTFU.
Donor lymphocyte infusion is a method used after an allogeneic transplant to help the body destroy any remaining malignant cells. Administration of immunosuppressive medications is stopped, and then immune cells from the original donor are infused. The immune response of the donor cells against the malignant cells in the patient can induce a remission. This is called a graft-vs.-leukemia (GVL) or graft-vs.-tumor (GVT) effect. Because the infusion of donor cells can cause graft-vs.-host disease (GVHD), clinical trials are testing methods to reduce the risk of GVHD without decreasing the effectiveness of the GVL or GVT effect. One such method is dose escalation, where a low number of cells is given for the first infusion, and higher numbers of cells are given for subsequent infusions if the first infusion did not cause GVHD. See Donor lymphocyte infusion. For information on clinical trials using DLI, go to www.clinicaltrials.gov and search on "donor lymphocyte infusion."
Gleevec is a therapy used to treat chronic myeloid leukemia (CML) when a DNA abnormality called the Philadelphia chromosome is present. This therapy was first made available for treatment of CML in May 2001. Gleevec interferes with the abnormal proliferation of cells that have a Philadelphia chromosome. Gleevec is not used to treat other forms of leukemia. Gleevec may be used for treatment of relapse after a transplant as a way to reduce the number of abnormal cells before donor lymphocyte infusion. For information about the FDA's approval of Gleevec, see: