|
|
 Previous Article | Table of Contents | Next Article 
Allogeneic bone marrow transplantation for leukemia with marrow grafts
depleted of lymphocytes by counterflow centrifugation
A Schattenberg, T De Witte, F Preijers, J Raemaekers, P Muus, N Van der Lely, J Boezeman, J Wessels, B Van Dijk and J Hoogenhout
Division of Hematology, University Hospital Nijmegen, The Netherlands.
Eighty consecutive patients were transplanted with human leukocyte antigen
(HLA)-identical sibling marrow for acute myelogenous leukemia (AML, N =
29), acute lymphoid leukemia (ALL, N = 23), or chronic myelogenous leukemia
(CML, N = 28). Donor marrow was depleted of lymphocytes using counterflow
centrifugation. Median age of the recipients was 31 years. Pretransplant
conditioning consisted of cyclophosphamide and fractionated total body
irradiation (TBI) with a low (4.1 +/- 0.3 cGy/min) or high (13.1 +/- 1.6
cGy/min) midline average dose rate. In 43 patients, cytosine-arabinoside or
anthracyclines were added to the conditioning regimen. Immunoprophylaxis
posttransplant consisted of methotrexate (MTX) alone, cyclosporine A (CsA)
in combination with MTX, or CsA alone; two patients received no
immunoprophylaxis at all. Graft failure occurred in 4 of 77 evaluable
patients (5%). The probability of acute graft- versus-host disease (GVHD)
greater than or equal to grade 2 at day 100 after transplantation was 15%.
The projected 3-year estimate of extensive chronic GVHD was 12%. Only three
patients died of cytomegalovirus-interstitial pneumonitis. The projected
3-year probability of relapse was 30% (95% confidence interval [CI], range
8% to 53%) in transplants for AML in first complete remission (CR1), 35%
(95% CI, 1% to 69%) after transplantation for ALL in CR1, and 38% (95% CI,
2% to 74%) after transplantation for CML in first chronic phase (CP1). The
projected 3-year probability of leukemia-free survival (LFS) was 56% (95%
CI, 35% to 77%) after transplantation for AML-CR1, 42% (95% CI, 16% to 69%)
in patients transplanted for ALL-CR1, and 49% (95% CI, 18% to 80%) after
transplantation for CML-CP1. After transplantation for AML-CR1, ALL-CR1, or
CML-CP1, the median follow-up time for leukemia-free survivors was 31+,
30+, and 21+ months, respectively. Probabilities of relapse, survival, and
LFS in AML-CR1 and ALL-CR1 transplants were comparable with those reported
in recipients of untreated grafts. In patients transplanted for CML-CP1,
probability of relapse was higher and probability of LFS was lower than in
recipients of untreated grafts. In transplants for leukemia in CR1 and CP1,
preparative regimen and immunoprophylaxis posttransplant were not
associated significantly with the probability of acute GVHD greater than or
equal to grade 2, extensive chronic GVHD, relapse, survival, or LFS. In
bone marrow transplantation for leukemia, counterflow centrifugation is a
useful technique for the prevention of GVHD.(ABSTRACT TRUNCATED AT 400
WORDS)
Volume 75,
Issue 6,
pp. 1356-1363,
03/15/1990
Copyright © 1990 by The American Society of Hematology
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
A. Urbano-Ispizua, C. Rozman, P. Pimentel, C. Solano, J. de la Rubia, S. Brunet, J. Perez-Oteyza, C. Ferra, J. Zuazu, D. Caballero, et al.
Risk factors for acute graft-versus-host disease in patients undergoing transplantation with CD34+ selected blood cells from HLA-identical siblings
Blood,
June 28, 2002;
100(2):
724 - 727.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Urbano-Ispizua, C. Rozman, P. Pimentel, C. Solano, J. de la Rubia, S. Brunet, J. Perez-Oteiza, C. Ferra, J. Zuazu, D. Caballero, et al.
The number of donor CD3+ cells is the most important factor for graft failure after allogeneic transplantation of CD34+ selected cells from peripheral blood from HLA-identical siblings
Blood,
January 15, 2001;
97(2):
383 - 387.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Urbano-Ispizua, C. Rozman, C. Martinez, P. Marin, J. Briones, M. Rovira, P. Feliz, M. Cruz Viguria, A. Merino, J. Sierra, et al.
Rapid Engraftment Without Significant Graft-Versus-Host Disease After Allogeneic Transplantation of CD34+ Selected Cells From Peripheral Blood
Blood,
June 1, 1997;
89(11):
3967 - 3973.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
