Use of a five-agent GVHD prevention regimen in recipients of unrelated donor marrow

A five-agent GVHD prophylaxis programme consisting of cyclosporin A, methot rexate, anti-thymocyte-globulin, pentaglobin and metronidazol was given to 48 recipients of unrelated donor marrow with chronic myelogenous leukemia, acute leukemia, myelodysplastic syndromes, and familiar lymphocytic hemopha gocytosis of an average age of 33.5 (0.6-56) years, GVHD grades II-IV occur red in 18 patients (39%) and grades III-IV in five patients (11%), Chronic GVHD developed in nine patients (23%), three limited and six extensive. Fif teen patients died. Clinical relapse was detected in eight patients. Four p atients died as a consequence of the underlying disease and subsequent trea tment, 11 patients died of transplant-related causes. After a median follow -up of 19 months, the overall and disease-free survival are 67% and 62%, re spectively, Survival by age is as follows: 0-19 years: 12/13 patients; 20-3 9 years: 14/25 patients; 40-59 years: 7/10 patients. The five-agent GVHD pr ophylaxis regimen is effective. Matched-unrelated donor transplants can be carried out safely in patients younger than 50 years of age. The results in patients younger than 20 years of age should encourage matched-unrelated d onor transplants at earlier stages of the disease.