BONE-MARROW TRANSPLANTATION FROM UNRELATE D DONORS IN CHRONIC MYELOID-LEUKEMIA - THE RESULTS OF 15 PATIENTS

Background: Bone marrow transplantation (BMT) from a histocompatible d onor is the only curative treatment in chronic myeloid leukemia (CML). Only a minority of patients dispose of an adequate donor from among h is/her relatives. The remaining transplant receptors must look to unre lated donors (URD). The experience of the Escuela de Hematologia Farre ras Valenti (Farreras Valenti School of Hematology, Barcelona, Spain) in BMT from URD in CML in the first chronic phase is herein reported. Methods: Fifteen patients (9 males and 6 females, median age 33 years; range 14-48 years) were transplanted from October 1988 to May 1994. S erologic identity was expressed in the A, B and D loci in 9 cases and minor incompatibility in 6. Conditioning included total body irradiati on and cyclophosphamide in 14 patients and busulphan plus cyclophospha mide in 1. Partial and selective T lymphocyte depletion was performed by elutriation in 7 cases. Results: Primary implant failure was detect ed in 2 out of 14 risk patients (14%) and secondary failure was observ ed in 3 out of 12 cases (25%). The actuarial probability of acute graf t versus host disease (GVHD) was 55 +/- 15% at 7 weeks with a probabil ity of appearance with an intensity of II-IV of 31 +/- 13%. Five out o f 7 patients with a survival of greater than 100 days, developed chron ic GVHD (71%). Ten presented fatal complications. In 5 cases, death wa s due to pulmonary problems. Recurrence of CML was not observed in any of the patients in the series. The probability of disease free surviv al at 2 years was 30 +/- 12%. Conclusions: Bone marrow transplantation from an unrelated donor is an effective treatment for a proportion of patients with chronic myeloid leukemia although severe complications are frequent and originate a high mortality.