Is there a graft-versus-leukaemia effect in the absence of graft-versus-host disease in patients undergoing bone marrow transplantation for acute leukaemia?
O. Ringden et al., Is there a graft-versus-leukaemia effect in the absence of graft-versus-host disease in patients undergoing bone marrow transplantation for acute leukaemia?, BR J HAEM, 111(4), 2000, pp. 1130-1137
During a 13-year period, 5200 autografts, 1039 HLA-identical sibling transp
lants without acute or chronic graft-vs.-host disease (GVHD) and 67 twins w
ere reported to the European Group for Blood and Marrow Transplantation EBM
T. Follow-up time was a median of 32 months. Diagnoses were acute myeloid l
eukaemia (AML, 4521) and acute lymphoblastic leukaemia (ALL, 1785) in first
complete remission. The probability of relapse at 5 years was 51 +/- 1% in
the autografts, 45 +/- 8% in the twins and 34 +/- 2% among the HLA-identic
al siblings (auto vs, sibs, P < 0.0001). In multivariate analyses, the foll
owing factors were significantly associated with an increased risk of relap
se: ALL vs, AML M3 [relapse rate (RR) 2.29, P < 0.0001], AML non-M3 vs. AML
M3 (RR 1.8, P < 0.0001), autograft vs. sibling transplant (RR 1.76, P < 0.
0001), interval diagnosis to transplantation < 261 d (RR 1.45, P < 0.001) a
nd other conditioning vs, total body irradiation (RR 1.16, P = 0.001). Tran
splant-related mortality was the same in the three groups at approximately
10% at 2 years. Five-year leukaemia-free survival was 42 +/- 1% in the auto
grafts, 44 +/- 8% in the twins and 58 +/- 2% among the siblings (auto vs. s
ibs, P < 0.0001). The factors significant for relapse were also significant
in multivariate analyses for leukaemia-free survival. In addition, childre
n had a significantly better leukaemia-free survival than adults (RR 0.82,
P < 0.0001). Recipients of bone marrow from HLA-identical siblings without
GVHD had a lower risk of relapse and a better leukaemia-free survival than
recipients of autografts. This mag be as a result of a graft-vs.-leukaemia
effect in the absence of GVHD.