ABSTRACT
Persistence of bcr-abl transcripts after marrow grafting is thought to convey a high risk for relapse in patients with Philadelphia chromosome (Ph)-positive acute lymphoblastic leukemia (ALL). Donor leukocyte infusion (DLI) is closely associated with development of graft-versus-host disease (GVHD) and has well-defined activity against relapsed chronic myelogenous leukemia (CML) but not ALL. We report two patients with Ph-positive ALL who remained bcr-abl positive by reverse transcriptase polymerase chain reaction (RT-PCR) after marrow grafting. Residual bcr-abl transcripts in both patients were eliminated following acute GVHD, which was induced by either DLI or rapid reduction of immunosuppression. Both patients have continued in complete molecular remission for 18 months and 8 months following transplantation, respectively. Our observation suggests that induction of GVHD may eliminate minimal residual disease, thereby preventing leukemia relapse in patients transplanted for Ph-positive ALL.
Subject(s)
Graft vs Leukemia Effect , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Neoplasm, Residual/therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Stem Cell Transplantation , Clone Cells/pathology , Female , Fusion Proteins, bcr-abl/analysis , Fusion Proteins, bcr-abl/genetics , Graft vs Host Disease/etiology , Humans , Immunosuppression Therapy , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology , Leukocyte Transfusion , Male , Middle Aged , Neoplasm, Residual/pathology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology , RNA, Messenger/analysis , Transplantation, HomologousSubject(s)
Fusion Proteins, bcr-abl/analysis , Hematopoietic Stem Cell Transplantation , Leukocyte Transfusion , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Blood Cells/cytology , Blood Cells/transplantation , Clone Cells/chemistry , Clone Cells/pathology , Fusion Proteins, bcr-abl/genetics , Humans , Male , Middle Aged , Reverse Transcriptase Polymerase Chain Reaction , Secondary PreventionABSTRACT
The planar structure of aculeximycin (1) produced by Streptosporangium albidum has been determined by spectral methods and chemical degradations such as 1,8-diazabicyclo[5,4,0]undec-7-ene (DBU)-methanol reaction, ozonolysis, and periodative oxidation. The antibiotic consists of a 30-membered polyhydroxy lactone ring, an alpha, beta-unsaturated ester group, an intramolecular hemiketal, an oligosaccharide (aculexitriose), a neutral sugar and an amino sugar. The structure of aculeximycin is closely related to those of sporaviridins produced by Streptosporangium viridogriseum. We consider that aculeximycin and sporaviridins belong to a new class of macrolide antibiotics, which is different from the polyol macrolides produced by Streptomyces.
