Managing Relapse

Relapse of CML occurs in approximately 10% of patients who undergo myeloablative allogeneic transplantation for chronic phase disease, and in more than 50% of patients with blastic phase disease. Higher relapse rates occur in identical twins and in T-cell depleted transplants, and lower relapse rates occur in patients developing GVHD. These data led to the use of donor lymphocyte infusions to treat patients who relapsed following allogeneic transplantation.19 20 A majority of patients who recur achieve sustained molecular remissions with appropriately administered DLI. Escalating dose schedules of DLI reduce the frequency of GVHD and marrow aplasia, and improve the effectiveness of this procedure.20

Molecular testing for Bcr-Abl transcripts can be used to identify patients who are likely to relapse. Detection of Bcr-Abl transcripts 6 to 12 months following transplantation is highly predictive of subsequent relapse, whereas detection less than 3 months or more than 18 months from transplantation is less predictive.

Quantification of Bcr-Abl offers more reliable prediction of hematologic relapse. Patients with persistently high levels of transcripts or with increasing Bcr-Abl transcripts are highly likely to relapse.

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