LEUKEMIA-FREE SURVIVAL AND MORTALITY IN PATIENTS WITH REFRACTORY OR RELAPSED ACUTE-LEUKEMIA GIVEN MARROW TRANSPLANTS FROM SIBLING AND UNRELATED DONORS

Between April 1982 and February 1997 39 patients (24 male, 15 female) with refractory acute leukemia and a median age of 31 years (19-51 yea rs) received allogeneic marrow grafts from an HLA-identical sibling (n = 27), HLA-identical unrelated donor (MUD; n = 10) or 1-antigen misma tched unrelated donor (n = 2). Twenty-eight patients had acute myeloge nous leukemia and 11 acute lymphoblastic leukemia. For conditioning mo st patients received total body irradiation combined with cyclophospha mide (ii = 23) or etoposide (n = 7). For graft-versus-host disease pro phylaxis patients received cyclosporin A (CsA) and methotrexate (MTX) (n = 20), MTX alone (II = 3), CsA and methylprednisone (rt = 6), or Cs A alone (n = 10), respectively. As of June 1997 probability of leukemi a-free survival projected to 3 years after BMT n as 14% for patients g iven sibling marrow grafts and 28% after MUD transplantation. Transpla nt-related mortality projected to 3 years was 32% after sibling and 37 % after MUD marrow grafting. Although not significantly different, pro bability of relapse projected to 3 Sears after BR?IT was lower after M UD at 56% compared to 78% with sibling BRIT. Thus, high-dose chemo/rad iotherapy followed by allogeneic marrow infusion has a curative potent ial for patients with refractory leukemia and offers the chance of lon g-term disease-free survival for some patients.