ALLOGENEIC BONE-MARROW TRANSPLANTATION WITH T-CELL-DEPLETED PARTIALLYMATCHED RELATED DONORS FOR ADVANCED ACUTE LYMPHOBLASTIC-LEUKEMIA IN CHILDREN AND ADULTS - A COMPARATIVE MATCHED COHORT STUDY

Allogeneic BMT provides the best treatment currently available for lon g-term disease-free survival in patients with recurrent ALL. Historica lly, partially matched related donors provided the opportunity for tre atment to a greater number of patients than matched related donors at the expense of decreased overall survival. In this study we compare th e results in recurrent ALL patients transplanted with either HLA ident ical sibling bone marrow or partially matched related bone marrow. Thi rty-two patients with relapsed ALL received partially matched bone mar rows from a relative with one to three HLA, A, B and Dr antigen mismat ches. Bone marrow was partially T cell-depleted with murine T10B9.1A-3 1 moAb. Sixteen patients with relapsed ALL received HLA-matched siblin g bone marrows. All partially matched patients received additional GVH D prophylaxis with methylprednisolone in addition to anti-CD5 immunoto xin and/or CYA. All matched patients in addition to methylprednisolone received MTX and/or CYA. We observed no difference in disease-free su rvival between patients transplanted with partially matched bone marro w (median follow-up 1252 days, range 778-2035 days) vs those transplan ted with HLA-matched bone marrow (median follow-up 1472 days, range 11 65-2800 days; P = 0.48). Median survival for all patients is 38% (95% CI 24-52%) at 6 years. Patients transplanted in remission had a signif icant increase in disease-free survival when compared to those in rela pse (P = 0.007). Our data suggest that partially matched BMTs from rel ated donors are a comparable alternative to fully matched transplants in patients with ALL.