LONG-TERM FOLLOW-UP OF A RANDOMIZED TRIAL COMPARING T-CELL DEPLETION WITH A COMBINATION OF METHOTREXATE AND CYCLOSPORINE IN ADULT LEUKEMIC MARROW TRANSPLANT RECIPIENTS

Forty-eight adult leukemic recipients of HLA-identical sibling marrow were randomized to T cell depletion using anti-CDS and anti-CD6 antibo dies plus complement (n=23) or prophylaxis with methotrexate (MTX) and cyclosporine (CsA) (n=25). Patient characteristics were comparable in the two groups. The median observation time was 51/2 years. Transfusi ons, infections, and acute GVHD did not differ between the groups. Chr onic GVHD occurred in 52% of patients receiving T cell-depleted marrow and 23% of those receiving MTX+CsA (P=0.06). Overall probability of r elapse was similar in both groups and actuarial leukemia-free survival s at 5 years were 39% and 35% in the two groups, respectively. Among p atients with chronic myeloid leukemia (CML), leukemia-free survival at 5 years was 25% in patients receiving T cell-depleted marrow compared with 51% in those given MTX+CsA (P=0.09). In patients with acute leuk emia the probability of relapse was 24% in the group receiving T cell- depleted marrow compared with 73% in those treated with MTX+CsA (P=0.0 6). Leukemia-free survival was 55% and 21% in the two groups, respecti vely (NS). CML patients tended to have a poorer prognosis and those wi th acute-leukemia better outcome with T cell depletion than with combi ned MTX+CsA. It is concluded that T cell depletion is unsuitable for p atients with CML, but may be considered in patients with acute leukemi a.