PROGNOSTIC FACTORS FOR LONG-TERM SURVIVAL IN LEUKEMIC MARROW RECIPIENTS WITH SPECIAL EMPHASIS ON AGE AND PROPHYLAXIS FOR GRAFT-VERSUS-HOST DISEASE

Long-term survival of 182 leukemic patients after allogeneic bone marr ow transplantation (BMT) was analyzed retrospectively regarding the ty pe of graft-versus-host disease (GvHD) prophylaxis and patient age. Mo notheraphy with either methotrexate (MTX) (n = 59) or cyclosporin (CSA ) (n = 40) was given to 79 patients less than 30 years of age and to 2 0 older patients. These patients were compared to those receiving a co mbination of MTX + CSA (n = 55) or T-cell depletion (TCD) (n = 28) (3 8 patients less-than-or-equal-to 30 and 45 > 30 years of age). Patient characteristics were similar in the two pairs of groups. The median f ollow-up time was between 4.7 and 9.6 years in the different groups. I n younger patients, the incidence of grade II-IV acute GvHD was 38% am ongst those treated with MTX or CSA and 14% in the MTX + CSA/TCD group (p = 0.008). Forty percent of older patients on monotherapy developed grade II-IV acute GvHD compared to 26% of those over 30 treated with MTX+CSA/TCD (ns). As a consequence, mortality from GvHD among younger patients was 19% in the monotherapy group and 3% in the MTX + CSA / TC D group (p=0.03) with 37% and 10% (p=0.04) in the older patient groups . The cumulative incidence of chronic GvHD was similar amongst treatme nts in the younger patients (39% in monotherapy and 39% in MTX + CSA/T CD), but was significantly lower in the MTX+CSA/TCD group among patien ts > 30 (55% vs 25%, p = 0.05). The actuarial overall survival at 5 ye ars was unchanged in patients less-than-or-equal-to 30, 49% and 43% in the monotherapy and MTX+CSA/TCD groups, respectively. However, in old er patients survival increased from 25% to 46% (p=0.04). An increase i n leukemic relapse associated with MTX+CSA/TCD among both younger (26% vs 48%, p = 0.05) and older patients (0% vs 46%, p = 0.05) influenced the relapse-free survival, 48% vs 39% (ns) in younger and 25% vs 37% (ns) in older patients. Risk-factors for survival were dependent on th e type of GvHD prophylaxis used. Using monotherapy, in contrast to com bination therapy or TCD, multivariate analysis showed that recipient a ge > 30 years and HLA disparity between donor and recipient were corre lated with poor outcome. In patients receiving MTX+CSA or TCD, a femal e donor to a male recipient correlated significantly with poor surviva l, which was not the case with monotherapy. Disease status beyond 1st complete remission (1 CR) or 1st chronic phase (1 CP), grade II-IV acu te GvHD and recipient CMV seropositivity were significant risk-factors among all patients regardless of the type of GvHD prophylaxis.