Therapy of relapse DLI and imatinib

ALL in relapse after transplantation is rarely salvaged by donor lymphocyte infusion. This observation is consistent but confusing, since there does appear to be a measurable GVL response in primary transplantation. Less than 20% of patients will achieve a remission to DLI alone52,53; however, this number may be increased with concomitant chemotherapy. Despite this, remissions are rarely durable. Imatinib has been used as therapy for relapse after transplantation of ALL54; however, the majority of the reported experience in relapsed Ph+ malignancies is in chronic myeloid leukemia (CML)55,56 or the lymphoblastic phase of CML.57 58 The combination of imatinib and DLI may prove to an important therapeutic modality for relapsed ALL. Attempts at second transplantation have been made with reasonable success, with long-term survival in up to 30% of patients.59

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