INFLUENCE OF GRAFT-VERSUS-HOST DISEASE ON OUTCOME FOLLOWING ALLOGENEIC TRANSPLANTATION WITH RADIATION-FREE PREPARATIVE THERAPY IN PATIENTS WITH ADVANCED LEUKEMIA

Between March 1984 and March 1995, 76 patients with advanced acute mye logenous, acute lymphoblastic, or chronic myelogenous leukemia underwe nt allogeneic marrow transplantation from HLA-identical or one-antigen mismatched sibling or unrelated donors, Patients received a preparati ve regimen consisting of busulfan 16 mg/kg and cyclophosphamide 120 mg /kg or busulfan 14 mg/kg, cyclophosphamide 120 mg/kg and etoposide (VP -16) 50 mg/kg, For GVHD prevention, patients received cyclosporine wit h either methotrexate or steroids or FK506 with methotrexate. Fourteen patients were leukemia-free survivors at a median of 6.5 years (range 1-11 years) following transplantation, For the group as a whole, the estimated leukemia-free survival (LFS) at 5 years is 20% (95% confiden ce interval Ten of the 14 leukemia-free survivors acute GVHD greater t han grade II and chronic GVHD and two developed only chronic GVHD, Sig nificantly better relapse rates and disease-free survival were associa ted with the development of acute and/or chronic GVHD, In the absence of acute GVHD and/or chronic GVHD, patients who underwent transplantat ion for advanced leukemia, after preparation with Bu/CY or Bu/CY/VP-16 , were very likely to experience disease recurrence, Novel strategies designed to promote development of GVHD present a promising area for i nvestigation to improve outcome in patients with leukemia at high risk for relapse.