J. Aschan et al., INDIVIDUALIZED PROPHYLAXIS AGAINST GRAFT-VERSUS-HOST DISEASE IN LEUKEMIC MARROW TRANSPLANT RECIPIENTS, Bone marrow transplantation, 14(1), 1994, pp. 79-87
Seventy-three leukemic HLA-identical siblings undergoing BMT received
individualized prophylaxis against GVHD based on estimated risk of GVH
D development. Patients with an estimated low risk of GVHD were given
MTX. MTX + CsA were given to patients having a high risk of GVHD. CsA
treatment was discontinued as early as possible after engraftment foll
owed by weekly MTX until 3 months after BMT. Conditioning was busulfan
+ CY (BuCY, n = 35) or CY/TBI (n = 38). CY/TBI patients given MTX com
bined with CsA for 1 year served as retrospective controls (n = 39). T
he incidence of acute GVHD was similar in the three groups. The incide
nce of chronic GVHD was 59% in the BuCY group and 40% in the CY/TBI gr
oup compared with 25% in the controls (p = 0.002 vs BuCY). The inciden
ce of relapse at 2 years was 6% in the BuCY group and 35% in the CY/TB
I group (p = 0.01) vs 36% in the control group (p = 0.01 vs BuCY). Act
uarial 2-year relapse-free survival was 76, 58 and 51% in the three gr
oups, respectively (p = 0.06, BuCY vs controls). In multivariate analy
sis individualized prophylaxis was associated with chronic GVHD. Poor
survival correlated with high risk leukemia and absence of chronic GVH
D. Poor relapse-free survival was associated with high risk leukemia a
nd TBI.