CYCLOSPORINE-A AS GVHD PROPHYLAXIS IN ALLOGENEIC BMT FOR CHILDHOOD ACUTE-LEUKEMIA

We report the preliminary results of a prospective randomized study on the impact of two different dosages of Cyclosporine A (Cs-A) on proba bility of development of acute and chronic GVHD, transplant-related mo rtality (TRM), relapse rate (RR) and event-free survival (EFS). Fifty- nine pediatric patients given BMT from an HLA-identical sibling were c entrally randomized to receive either Cs-A at a dosage of 1 mg/kg/die (CsA1) or at a dosage of 3 mg/kg/die (CsA3) intravenously for the firs t 21 days after BMT, Patients given Cs-A at a dosage of 1 mg/kg/die ha d a higher probability of developing acute GVHD, but a lower relapse r ate, which translated into a better probability of EFS.These prelimina ry results to be confirmed with a longer follow-up suggest that the us e of low doses of CsA is feasible even though associated with a higher incidence of GVHD, but without any increment in TRM, The reduction of immunosuppressive treatment after BMT favoured the development of a g raft-versus-leukemia effect, which seems to play a relevant role in pr eventing leukemia recurrence and in improving the cure rate.