OUTCOME OF ALLOGENEIC BONE-MARROW TRANSPLANTATION WITH LYMPHOCYTE-DEPLETED MARROW GRAFTS IN ADULT PATIENTS WITH MYELODYSPLASTIC SYNDROMES

Thirty-five patients with myelodysplastic syndromes (MDS) were treated with BMT between 1986 and 1994. Their median age was 41 years (range 23-60), Thirteen patients had transfusion-dependent refractory anaemia (RA), Twenty-two patients suffered from more advanced stages of MDS, 15 being in complete remission (CR) after chemotherapy, In 31 recipien ts, pretransplant conditioning consisted of cyclophosphamide and TBI w ith or without the addition of idarubucin; four patients were conditio ned with other schedules, Donors were genotypically HLA-identical and MLC-negative siblings in 32, and others in three cases, All patients r eceived a graft depleted of 98% of T lymphocytes using counterflow cen trifugation, Fourteen patients are alive and in continuous remission w ith a median follow-up of 20 months (range 15-113) after BMT, Seven pa tients relapsed between 3 and 18 months after BMT and subsequently die d, Fourteen transplantation-related deaths occurred, Outcome in patien ts under and over 40 years old was comparable, The probability of dise ase-free survival (DFS) at 2 years after BMT was 39% (95% confidence i nterval (CI), 22-56%), Considering patients with HLA-identical and MLC -negative sibling donors transplanted for RA (it = 11) or more advance d stages of MDS in CR (it = 14), the probabilities of DFS were 73% (95 % CI, 47-99%) and 42% (95% CI, 15-69%), respectively, This indicates t hat BMT with lymphocyte-depleted grafts can cure a substantial number of relatively old patients with MDS, especially when grafts from HLA-i dentical and MLC-negative siblings are used and patients are suffering from RA.