INTERSTITIAL PNEUMONITIS IN ACUTE-LEUKEMIA PATIENTS SUBMITTED TO T-DEPLETED MATCHED AND MISMATCHED BONE-MARROW TRANSPLANTATION

Purpose: To identify factors that could contribute to interstitial pne umonitis (IP), which remains one of the major causes of morbidity and mortality after both matched and mismatched bone marrow transplantatio n (BMT). Methods and Patients: Ninety acute leukemia patients received an allogeneic T-depleted matched (n = 54) or mismatched (N = 36) BMT. They were preconditioned with total body irradiation (TBI), thiotepa, rabbit anti-thymocyte globulin, and cyclophosphamide. The TBI scheme was hyperfractionated in matched, and a single dose in mismatched pati ents. The dose to the lungs was reduced in both groups. Results: Five of the 54 matched patients developed IF. All cases mere fatal. There w ere 16 cases of TP, 13 fatal, in the mismatched group. The probability of developing IP was 11.3 +/- 4.9% and 48.6 +/- 9.0%, respectively. T he between-group difference was statistically significant (p < 0.0001) . The type of transplant and the TBI scheme were the most important pa rameters for IP development in univariate analysis, whereas acute graf t-versus-host disease, disease stage and sex were nonsignificant. Medi an follow-up was 342 days (range 17-2900).Conclusions: The low inciden ce of IP in matched patients and the lack of idiopathic cases are evid ence for the validity of the TBI schedule. In contrast, the incidence in mismatched patients remains too high; therefore, new strategies sho uld be studied in an attempt to lower it. (C) 1998 Elsevier Science In c.