LOW INCIDENCE OF ACUTE GRAFT-VERSUS-HOST DISEASE, USING UNRELATED HLA-A-COMPATIBLE, HLA-B-COMPATIBLE, AND HLA-DR-COMPATIBLE DONORS AND CONDITIONING, INCLUDING, ANTI-T-CELL ANTIBODIES

Background Using unrelated bone marrow, there is an increased risk of graft-versus-host disease (GVHD). Methods. HLA-A-, HLA-B-, and HLA-DR- compatible unrelated bone marrow was given to 132 patients. The diagno ses included chronic myeloid leukemia (n=43), acute lymphoblastic leuk emia (n=29), acute myeloid leukemia (n=27), myelodysplastic syndrome ( n=4), lymphoma (n=3), myeloma (n=1), myelofibrosis (n=1), severe aplas tic anemia (n=12), and metabolic disorders (n=12), The median age was 25 years (range 1-55 years). HLA class I was typed serologically, and class II was typed by polymerase chain reaction using sequence-specifi c primer pairs. Immunosuppression consisted of antithymocyte globulin or OKT3 for 5 days before transplantation and methotrexate combined wi th cyclosporine. Results. Engraftment was seen in 127 of 132 patients (96%). Bacteremia occurred in 47% cytomegalovirus (CMV) infection in 4 9% and CMV disease in 8%. The cumulative incidences of acute GVHD grea ter than or equal to grade IT and of chronic GVHD were 23% and 50%, re spectively. The 5-year transplant-related mortality rate was 39%. The overall B-year patient survival rate was 49% in patients with metaboli c disorders and severe aplastic anemia, it was 61% and 48%, respective ly. The disease-free survival rate was 47% in patients with hematologi cal malignancies in first remission or first chronic phase and 38% in patients with more advanced disease (P=0.04). Acute GVHD was associate d with early engraftment of white blood count (P=0.02). Poor outcome i n multivariate analysis was associated with acute myeloid leukemia (P= 0.01) and CMV disease (P=0.04). Conclusion. Using HLA-A-, HLA-B-, and HLA-DR-compatible unrelated bone marrow and immunosuppression with ant ithymocyte globulin, methotrexate, and cyclosporine, the probability o f GVHD was low and survival was favorable.