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Allogeneic bone marrow transplantation from unrelated donors using in vivo anti-T-cell globulin.
- Source :
- British Journal of Haematology; Oct2000, Vol. 111 Issue 1, p303-313, 11p, 4 Graphs
- Publication Year :
- 2000
-
Abstract
- 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 leukaemia 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 × 10<superscript>9</superscript>/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 chimaerism or elimination of minimal residual disease. Our results are similar to data obtained after matched sibling donor transplantation. [ABSTRACT FROM AUTHOR]
- Subjects :
- BONE marrow transplant complications
T cells
GLOBULINS
MYELOID leukemia
Subjects
Details
- Language :
- English
- ISSN :
- 00071048
- Volume :
- 111
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- British Journal of Haematology
- Publication Type :
- Academic Journal
- Accession number :
- 5605053
- Full Text :
- https://doi.org/10.1046/j.1365-2141.2000.02305.x