RISK-FACTORS IN BONE-MARROW TRANSPLANT RECIPIENTS WITH LEUKEMIA - INCREASED RELAPSE RISK IN PATIENTS TREATED WITH CIPROFLOXACIN FOR GUT DECONTAMINATION

Three hundred and six patients with low-and intermediate-risk leukaemi as undergoing allogeneic BMT between 1980 and March 1996 were studied regarding transplantation-related mortality (TRM), relapse, and leukae mia-free survival (LFS). Among the patients were 262 recipients of mar row from HLA-identical siblings and 44 patients receiving marrow from HLA-A, -B, and -DR identical unrelated donors. Between 1986 and 1993, 153 adult patients received ciprofloxacin continuously during Cy condi tioning, but since November 1993 ciprofloxacin has not been given unti l after Cy treatment. TRM at 5 yr showed an incidence of 30%. Signific ant risk factors in Cox regression multivariate analysis comprised acu te GVHD grades II-IV (p < 0.0001), seropositivity for 3-4 herpes virus es prior to BMT (p = 0.002), intermediate risk disease (p = 0.008), fe male donor to male recipient (p = 0.015), and a donor age over 17 yr ( p = 0.025). The risk of relapse was studied from 90 d after BMT, and t he overall 5-yr incidence was 32%. Significant risk factors comprised acute leukaemia, as compared to CML (p = 0.003), total body irradiatio n (TBI) compared to busulphan treatment (p = 0.011), gram-negative pro phylaxis with ciprofloxacin during cyclophosphamide (Cy) conditioning (p = 0.024), GVHD prophylaxis using a combination of methotrexate (MTX ) and cyclosporine (CSA), compared to monotherapy (p = 0.037) and abse nce of chronic GVHD (p = 0.050). The 5-yr probability of relapse in pa tients receiving ciprofloxacin prophylaxis during Cy conditioning was 40%, compared to 24% in patients not receiving this treatment (p = 0.0 1). Overall, LFS at 5 yr was 49%. LFS was evaluated from day 30 after BMT until relapse or death of the patient. We found no difference in T RIM, relapse or LFS between recipients of HLA-identical sibling or unr elated bone marrow, risk factors significantly associated with an infe rior LFS included acute GVHD grades II-IV (p = 0.0002), intermediate r isk disease (p = 0.003), donor seropositivity for 3-4 herpes viruses ( p = 0.046), and TBI conditioning (p = 0.048).