OUTCOME OF TRANSPLANTATION FOR STANDARD-RISK LEUKEMIA WITH GRAFTS DEPLETED OF LYMPHOCYTES AFTER CONDITIONING WITH AN INTENSIFIED REGIMEN

One hundred and eighty-one consecutive patients with standard-risk leu kaemia were transplanted with HLA-identical sibling grafts depleted of lymphocytes using counterflow centrifugation. In 116 patients, standa rd conditioning was intensified by the addition of anthracyclines. Mul tivariate analysis revealed significantly more acute GVHD greater than or equal to grade 2 and a trend towards more chronic GVHD in patients conditioned with the addition of anthracyclines. For all patients the risk for chronic GVHD, but not for acute GVHD, increased with a highe r number of T cells in the graft. The projected 5-year probability of relapse was significantly lower in the group of patients conditioned w ith anthracyclines; 26% versus 52% (P = 0.015). In multivariate analys is the addition of anthracyclines to the conditioning regimen was the only significant factor contributing to a lower probability of relapse . The projected 5-year probability of leukaemia-free survival [LFS] in the patients conditioned with and without the addition of anthracycli nes was 56% and 36%, respectively (P = 0.004). In multivariate analysi s the addition of anthracyclines to the conditioning regimen correlate d significantly with a lower number of mixed chimaeras in patients at 6 and 12 months after BMT. Mixed chimaerism at 6 months after transpla ntation did not significantly correlate with a higher incidence of rel apse in further follow-up. In contrast, mixed chimaerism at 12 months after BMT was significantly associated with higher relapse rate. We co nclude that the addition of anthracyclines to the conditioning regimen improves outcome of BMT using T-cell-depleted grafts.