Complete Remission Induced by Filgrastim (rhG-CSF) in the Case of Relapsed Acute Lymphoblastic Leukemia after Unrelated Cord Blood Transplantation

Abstract

We report the case of a 13-years-old male patient with relapsed acute lymphoblastic leukemia, after unrelated cord blood transplantation (CBT), who led to complete remission (CR) by Filgrastim (rhG-CSF). This patient achieved CR1 by induction chemotherapy, but the first relapse occurred at 16 months after the time of diagnosis. The CR2 was obtained with chemotherapy, then one HLA mismatched unrelated CBT was performed. Engraftment occurred and the BM aspirate showed 100% donor cells. But a BM aspirate obtained at 10 months showed relapse, with 56.5% blasts and 51.7% donor cells. After chemotherapy with vincristine and corticosteroid, BM aspirate showed partial remission with 6.8% blasts and 93.4% chimerism of donor’s cells. For graft-versus-leukemia effect Filgrastim (3.75μg/kg) was subcutaneously injected daily for 60 days. BM study performed at 1 month after completion of Filgrastim revealed CR3 and 99.8% donor’s cells. The third relapse happened at 6 months after CR3, and the patient died 3 months later although chemotherapy continued.