TRANSPLANTATION WITH UNRELATED BONE-MARROW IN LEUKEMIC PATIENTS ABOVE40 YEARS OF AGE

Twenty-seven patients above 40 years of age (range 40-55) with leukaem ia underwent transplantation with haematopoietic stem cells from HLA-A , -B and -DR identical unrelated donors, They were compared to 69 youn ger patients, median age 23, In the older group, the diagnoses were ac ute myeloid leukaemia (AML) five, acute lymphoblastic leukaemia (ALL) three and chronic myeloid leukaemia (CML) 19, The corresponding figure s in the younger patients were 21, 27 and 21, respectively, Conditioni ng consisted of cyclophosphamide (120 mg/kg) combined with 10 Gy total body irradiation, Immunosuppression was ATG or OKT3 for 5 days before transplantation and methotrexate combined with cyclosporin A, The pro babilities of grades II-IV acute graft-versus-host disease (GVHD) were 23 and 21%, and the cumulative incidences of chronic GVHD were 64 and 50% in the older and younger patient cohorts, respectively, Overall, 3-year transplant-related mortality rates were 46% in patients greater than or equal to 40 years of age and 32% in patients < 40 years of ag e (P = 0.16), Three-year patient survival rates were 54 and 46% in the two groups, respectively, In patients with chronic phase CML, the cor responding figures were 67 and 68%, respectively, We conclude that pat ients above 40 years of age should be considered for transplantation w ith marrow from unrelated donors.