LONG-TERM SURVIVAL IN ADVANCED CHRONIC MYELOGENOUS LEUKEMIA FOLLOWINGBONE-MARROW TRANSPLANTATION FROM HAPLOIDENTICAL RELATED DONORS

From 1987 to 1991, 26 patients with CML and a median age of 31 Sears r eceived allogeneic BMT from a partially mismatched related donor (PMRD ) who shared at least one haplotype with the recipient. Nine patients were in accelerated phase (AP), and 11 patients were in blast crisis ( BC) at the time of BMT. Patients were mismatched either in graft-versu s-host or host-versus-graft directions for one antigen in 3 patients, two antigens in 14 patients, and three antigens in 9 patients. All pat ients were prepared with a regimen consisting of total body irradiatio n, etoposide, cytosine arabinoside, cyclophosphamide and methylprednis olone. All marrows were treated ex vivo with T10B91 . A-31, a monoclon al antibody directed toward the alpha beta heterodimer of the CD3 rece ptor, and rabbit complement, Additional GVHD prophylaxis included eith er the anti-CD5 immunoconjugate XomaZyme-H65, cyclosporine, or both in combination with methylprednisolone. Eight patients did not have sust ained engraftment. The 100-day survival was 42%, The incidence of grea ter than or equal to grade II acute GVHD was 29%. The incidence of chr onic GVHD was 50% and was limited in all cases. The median survival at 4 years for all 26 patients was 27%, Seven patients (CP 1, AP 3, BC 3 ) remain in hematologic remission 1297-2241+ days after transplantatio n. AlloBMT from a PMRD may be considered for patients with advanced CM L who lack a matched sibling or unrelated donor.