PROGNOSTIC FACTORS AFFECTING LEUKEMIA RELAPSE AFTER ALLOGENEIC BMT CONDITIONED WITH CYCLOPHOSPHAMIDE AND FRACTIONATED TBI

Between June 1985 and May 1992, 94 consecutive patients with acute mye loid leukemia (AML = 28), acute lymphoblastic leukemia (ALL = 27) and chronic myelogenous leukemia (CML = 39), were transplanted using genot ypically HLA-identical marrow donors, All were conditioned with cyclop hosphamide (CY) plus 12 Gy fractionated TBI, Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporin A alone in nine patients and methotrexate-cyclosporin A in 85 patients, Forty-eight patients de veloped grades II-IV acute GVHD and 24 of 68 patients who survived at least 100 days developed chronic GVHD, The 5-year actuarial probabilit y of survival, event-free survival and relapse were 41 +/- 5%, 37 +/- 5% and 37 +/- 6%, respectively, In multivariate analysis, an increased risk of leukemia relapse was associated with (1) absence of chronic G VHD (P = 0.017), (2) advanced disease at transplant (P = 0.034) and (3 ) diagnosis of AML (P = 0.047), Our results confirm that disease statu s at transplant and chronic GVI-ID are the more important risk factors associated with leukemia relapse, and suggest that CY-TBI has only a partial role in eradicating leukemia in AML.