Allogeneic bone marrow transplantation from unrelated donors using in vivoanti-T-cell globulin

Despite improvements in HLA typing, graft-versus-host disease (GVHD) contin ues to impair the results after volunteer unrelated donor bone marrow trans plantation (VUD-BMT) in adult patients compared with matched sibling BMT. H ere, the outcome after VUD-BMT using a specific regimen with high-dose anti -T-lymphocyte globulin (ATG) was analysed. Fifty-five adult patients, media n age 34 years (range 17-55 years), with acute or chronic leukaemia or myel odysplastic syndrome (MDS) were transplanted in first complete remission (C R1)/first chronic phase (CP1) (early disease) (n = 21) or in advanced (CR2/ CP2, no remission) disease (n = 34) from an unrelated marrow donor. GVHD pr ophylaxis consisted of ATG-S (Fresenius) 60-90 mg/kg b.w. prior to transpla ntation, in addition to cyclosporin A and short-course methotrexate. Graft failure did not occur and white brood cell count (WBC) >1.0 x 10(9)/l was r eached at median day +16. The cumulative incidence of acute (a)GVHD grade I I-IV was 15% [95% CI (8%, 28%)] and of chronic GVHD was 51% [95% CI (38%, 6 8%)]. The cumulative incidence of relapse within 1 year was 0% [95% CI (0%, 19%)] and 21% [95% CI (11%, 40%)] for patients with early and advanced dis ease respectively. With a median follow-up of 28 months (range 16-45 months ), 2-year disease-free and overall survival for patients transplanted in CR 1/CP1 was 81% and 81% [95% CI (64%, 98%)], respectively and for patients wi th advanced disease was 33% [95% CI(17%, 50%)] and 40% [95% CI (23%, 57%)] respectively. Complete and persistent donor chimaerism was seen in 77.5% of 40 patients evaluated. All 14 chronic myeloid leukaemia (CML)-CP1 patients became bcr-abl negative within 250 d. High-dose ATG pretransplant results in a low incidence of severe aGVHD without compromising donor chimaerism or elimination of minimal residual disease. Our results are similar to data o btained after matched sibling donor transplantation.