MARROW TRANSPLANTS FROM UNRELATED DONORS FOR TREATMENT OF PHILADELPHIA-CHROMOSOME-POSITIVE ACUTE LYMPHOBLASTIC-LEUKEMIA

Transplantation of marrow from unrelated donors was investigated in pa tients with Philadelphia chromosome-positive (Ph1+) acute lymphoblasti c leukemia (ALL) who lacked a suitable family donor. Eighteen patients underwent transplantation at our canter between 1988 and 1995. The me dian patient age was 25 years (range, 1.7 to 51 years). Seven patients were in first complete remission, 1 in second remission, 3 in first r elapse, and the remaining 7 had more advanced or chemotherapy refracto ry leukemia at transplant. All patients were conditioned with cyclopho sphamide and total body irradiation followed by marrow transplants fro m closely HLA-matched, unrelated volunteers. Posttransplant; graft-ver sus-host disease (GVHD) prophylaxis included methotrexate with either cyclosporine or FK506. Graft failure was not observed, Severe (grades III-IV) GVHD appeared in 6 of 17 evaluable patients and chronic extens ive GVHD in 7 of 13 patients at risk. Five patients had recurrent ALL after transplantation and another 4 died from causes other than leukem ia. Six patients transplanted in first remission, 2 in first relapse, and 1 in second remission remain alive and leukemia-free at a median f ollow-up of 17 months (range, 9 to 73 months). The probability of leuk emia-free survival at 2 years is 49% +/- 12%. These data indicate that unrelated donor marrow transplantation is an effective treatment opti on for patients with early stage Ph1+ ALL without a family match and s uggest that in such patients an unrelated donor search should be initi ated as soon as possible after diagnosis. (C) 1997 by The American Soc iety of Hematology.