BOOSTER MARROW OR BLOOD-CELLS FOR GRAFT FAILURE AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION

Twenty allogeneic bone marrow transplant patients were treated with an additional dose of donor cells (boost dose) for graft failure (n = 7) , partial graft failure (n = 11) or extensive hemolysis caused by rema ining recipient cells producing anti-erythrocyte antibodies (n = 2), D onors were in 12 cases HLA-identical siblings, three mismatched relate d donors and five unrelated donors. Cell source was in 13 cases bone m arrow and in seven peripheral blood progenitor cells, Median time from BMT to booster dose was 3.4 months (range 0.7-59.3), Median infused c ell dose was 2.4 x 10(8)/kg patient (range 0.5-19.0), As GVHD prophyla xis most patients were already receiving different combinations of cyc losporine, prednisolone and methotrexate, No preparative treatment was given prior to boost in 16 patients; four received ATG, After boost, 11 patients developed acute GVHD, six grade I, four grade II and one g rade III, Except for one patient, acute GVHD after boost was less, or the same grade as after BMT, Six patients developed chronic GVHD, thre e limited and three extensive. Five patients died within 30 days of th e boost. Nine of 15 (60 %) evaluable patients became transfusion indep endent within 30 days and three more within 60 days. Causes of death w ere: infections six (IP four, pneumonia two), relapse three; and GVHD three. Three out of five patients transplanted with unrelated marrow s uffered from severe immunological reactions and died 2-3 months after the boost dose. Patient survival 1 and 3 years after boost was 55% and 43%, respectively. Among patients with hematological malignancies, le ukemia-free survival at 3 years was 41%.