TREATMENT OF PATIENTS WITH MYELODYSPLASTIC SYNDROMES WITH ALLOGENEIC BONE-MARROW TRANSPLANTATION FROM GENOTYPICALLY HLA-IDENTICAL SIBLINGS AND ALTERNATIVE DONORS

Between December 1981 and March 1994, 24 patients with a myelodysplast ic syndrome (MDS) underwent allogeneic bone marrow transplantation (BM T) for RA with trilineage dysplasia (n = 4), CMML (n = 1), RAEB (n = 4 ), RAEBt (it = 9) and AML following MDS (n = 6), Fifteen patients (two RAEB, seven RAEBt and six sAML) received chemotherapy before BMT resu lting in complete remission in 10 patients (six RAEBt and four sAML) a t the time of BMT, Sixteen marrow donors were genotypically HLA-identi cal siblings, Remaining donors were other family members (five) or unr elated donors (three). The status of the underlying disease at the tim e of conditioning was the major factor determining long-term survival, The disease-free survival of RA patients and patients presenting,vith RAEB, RAEBt and AML but transplanted in complete remission, was respe ctively 50 and 60%. On the contrary, none of the nine high-risk MDS pa tients transplanted with persistent disease, survived, Outcome after t ransplantation with alternative donors was inferior with one long-term survivor, mainly related to the high incidence of severe acute GVHD a nd its accompanying infectious complications, Six patients relapsed re sulting in an actuarial probability of relapse of 28%. Twelve patients died of transplant-related complications leading to a non-relapse mor tality at 5 years of 50%. At present eight patients are alive and dise ase-free 20 to 132 months post-transplantation resulting in an actuari al 5-year disease-free survival of 40.7%. Our results suggest that all ogeneic bone marrow transplantation is a feasible treatment option for patients with MDS, However, improvements in GVHD prophylaxis and supp ortive care to reduce transplant-related mortality and improved relaps e prevention are imperative.