EARLY CYCLOSPORINE TAPER IN HIGH-RISK SIBLING ALLOGENEIC BONE-MARROW TRANSPLANTS

Graft-versus-tumour reactions as a form of adoptive immunotherapy may help prevent the recurrence of haematological malignancy following all ogeneic BMT, We hypothesised that such reactions may be maximised by s hortening the duration of post-transplant immuno-suppression by a rapi d taper of cyclosporine (CYA). CYA dose was tapered between days 30 an d 60 in patients at high risk of relapse, provided there was no eviden ce of prior significant acute GVHD. Twenty-six of 58 high-risk patient s eligible at the time of transplant mere subsequently tapered, Seven (27%) developed grade III/IV acute GVHD after completion of the taper, which was fatal in one patient. Chronic GVHD was observed in most pat ients, although with minimal overall impact on performance status. The overall probability of survival at 2 years was 43%, This non-randomis ed experience indicates that a rapid taper of CYA is tolerable and may provide an alternative to immunotherapy with donor leukocyte infusion in the high-risk allograft setting.