Unrelated marrow donor results similar to related in study

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Allogeneic Bone Marrow Transplantation

from unrelated donors using in vivo

anti-T-cell globulin

Jürgen Finke,et.al.

Despite improvements in HLA typing, graft-versus-host

disease

(GVHD) continues to impair the results after volunteer

unrelated

donor bone marrow transplantation (VUD-BMT) in adult

patients

compared with matched sibling BMT. Here, the outcome

after

VUD-BMT using a specific regimen with high-dose

anti-T-lymphocyte globulin (ATG) was analysed.

Fifty-five adult patients, median age 34 years (range

17–55 years), with acute or

chronic leukemia or myelodysplastic syndrome (MDS)

were

transplanted in first complete remission (CR1)/first

chronic phase

(CP1) (early disease) (n = 21) or in advanced

(CR2/CP2, no

remission) disease (n = 34) from an unrelated marrow

donor.

GVHD prophylaxis consisted of ATG-S (Fresenius) 60–90

mg/kg

b.w. prior to transplantation, in addition to

cyclosporin A and

short-course methotrexate. Graft failure did not occur

and white

blood cell count (WBC) >1·0 × 109/l was reached at

median day

+16.

The cumulative incidence of acute (a)GVHD grade II–IV

was

15% [95% CI (8%, 28%)] and of chronic GVHD was 51%

[95%

CI (38%, 68%)]. The cumulative incidence of relapse

within 1 year

was 0% [95% CI (0%, 19%)] and 21% [95% CI (11%, 40%)]

for

patients with early and advanced disease respectively.

With a

median follow-up of 28 months (range 16–45 months),

2-year

disease-free and overall survival for patients

transplanted in

CR1/CP1 was 81% and 81% [95% CI (64%, 98%)],

respectively,

and for patients with advanced disease was 33% [95% CI

(17%,

50%)] and 40% [95% CI (23%, 57%)] respectively.

Complete and

persistent donor chimaerism was seen in 77·5% of 40

patients

evaluated. All 14 chronic myeloid leukaemia (CML)-CP1

patients

became bcr–abl negative within 250 d. High-dose ATG

pretransplant results in a low incidence of severe

aGVHD without

compromising donor chimerism or elimination of minimal

residual

disease. Our results are similar to data obtained

after matched

sibling donor transplantation.

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