ALLOGENEIC PERIPHERAL-BLOOD STEM-CELL TRANSPLANTATION - IS THERE AN INCREASED RISK OF GRAFT-VS-HOST DISEASE IN LEUKEMIA PATIENTS

Fifteen patients with hematological malignancies [9 acute nonlymphobla stic leukemia (ANLL), four chronic myelogenous leukemia (CML), two acu te lymphoblastic leukemia (ALL)] received allogeneic peripheral blood stem cell transplantation (alloPBSCT) from HLA-identical sibling donor s. Donors received 2.5-15 mu g/kg/day of recombinant human granulocyte colony stimulating factor (rhG-CSF) for 5-10 days. Administration of rhG-CSF was well tolerated except for mild to moderate bone pain occur ring in all the donors which was relieved by oral paracetamol. A total of 40 leukaphereses were performed for the 15 donors using the bilate ral antecubital veins. None of the donors needed central venous line i nsertion. The median number of apheresis procedures for each patient w as 3 (2-3). A median of 7.7 (4-38.2) x 10(8)/kg mononuclear cells, 35 (2.4-90.0) x 10(6)/kg CD34+ cells, 1.85 (0.45-4.8) x 10(8)/kg CD3 and 0.3 (0.16-1.01) x 10(8)/kg natural killer cells were given without any manipulation. Cyclosporin A (CsA) plus short-course methotrexate (MTX ) (12 patients) and CsA alone (3 patients) were used for graft versus host disease (GVHD) prophylaxis. Median granulocyte and platelet engra ftments were done on days 11 (10-31) and IG (11-54) respectively. Grad es II-IV GVHD occurred in 62% of the patients and grades III-TV in 15% . Twelve patients are still alive with full engraftment and disease-fr ee. In conclusion, alloPBSCT is an alternative to allogeneic bone marr ow transplantation, because of the ease of collection and rapid hemato logical recovery. However, there is a trend for increased acute GVHD i n our leukemia patients compared to allogeneic bone marrow.