Cyclosporin-A in allogeneic bone marrow transplantation for leukemia: Basle experience 1979 to 1984.
Since July 1979 all patients transplanted in Basle have been treated with Cyclosporin-A (CyA) as prophylaxis against Graft-versus-Host-Disease (GvHD). Currently CyA is given as a continuous infusion for 3-4 weeks, followed by an oral once-daily-therapy for one year. The daily dose is adjusted depending on the serum creatinine. Patients with acute GvHD during CyA therapy are treated with high dose bolus-steroid therapy. 83 patients with leukemia were treated in these 5 years. All were conditioned with 2 X 60 mg/kg Cyclophosphamide and 10 Gy total body irradiation. 78 had an HLA-identical, 5 an HLA-haploidentical family donor. The median age is 28 years (5-42 y). 20 patients had AML in 1. CR, 9 patients AML not in 1. CR (2nd, 3rd CR or relapse), 11 ALL in 1. CR, 19 not in 1. CR, 20 CML in chronic and 4 CML in accelerated phase. 40 patients are actually alive, well and without any signs of their disease; 9 are living in relapse. Major cause of death is relapse and GvHD. CyA does not reduce the incidence, it does reduce the severity of GvHD. The only long-term side-effects of bone marrow transplantation seen are cataracts and sterility. The major factors influencing outcome is the time of transplant. 31/51 patients transplanted in 1. CR or in chronic phase of CML are alive compared to only 9/32 transplanted in later stages. We conclude that bone marrow transplantation should be performed early in the disease and that CyA eases the procedure.
D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000188:drug therapy / Q000628:therapy; D016026:Bone Marrow Transplantation; D002386:Cataract / Q000150:complications; D002648:Child; D002675:Child, Preschool; D003524:Cyclosporins / Q000627:therapeutic use*; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality; D006087:Graft vs Host Reaction / Q000187:drug effects; D006801:Humans; D007246:Infertility / Q000150:complications; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000628:therapy*; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D013557:Switzerland; D014184:Transplantation, Homologous
D003524:Cyclosporins