The Use of a Sequential High Dose Recombinant Interleukin 2 Regimen After Autologous Bone Marrow Transplantation Does Not Improve the Disease Free Survival of Patients with Acute Leukemia Transplanted in First Complete Remission

Abstract

We report the outcome of 50 consecutive patients with CR1 acute leukemia (AML = 22; ALL = 28) treated with autologous BMT, after cyclophosphamide and TBI, followed with a sequential high dose rIL2 regimen. rIL-2 (RU 49637 from Roussel-Uclaf, Romainville, France) was started after hematological reconstitution an average of 72 ± 22 days post transplant. The schedule consisted of a continuous infusion over 5 cycles (Cycle 1: 5 days starting on day 1; cycle 2-5: 2 days starting on day 15, 29, 43 and 57). Patients were treated at 4 different dosages (12 (N = 40), 16 (N = 3), 20 (N = 2), 24 (N = 5) × 10⁶ IU/m2/day). Toxicities were mainly related to capillary leak syndrome and thrombocytopenia. Patients received an average of 122 ± 49 10⁶ IU/m²Two patients with AML died from toxicity. rIL-2 infusion was associated with very a high level of immune stimu-lation of both T-cells (P > 0.05) and natural killer (NK) cells (P > 0.05) and associated cytolytic functions (P > 0.05). With a minimal and median follow-up of 21 and 46 months, 3 year leukemia free survival is 41 ± 6% overall, 39 ± 10% and 43 ± 8% for AML and ALL respectively. Relapse probabilities at 3 years are 59 ± 11% for AML and 57 + 8% for ALL. We conclude that this short infusion of rIL-2 over 2 months, resulting in an increased immune stimulation, is not associated with a better leukemic control for patients with acute leukemia transplanted early after reaching first complete remission.

Key Words:

• Interleukin 2
• immunotherapy
• autologous bone marrow transplantation
• acute myeloid leukemia
• acute lymphoblastic leukemia