Long-term survival in advanced chronic myelogenous leukemia following bone marrow transplantation from haploidentical related donors.
From 1987 to 1991, 26 patients with CML and a median age of 31 years received allogeneic BMT from a partially mismatched related donor (PMRD) who shared at least one haplotype with the recipient. Nine patients were in accelerated phase (AP), and 11 patients were in blast crisis (BC) at the time of BMT. Patients were mismatched either in graft-versus-host or host-versus-graft directions for one antigen in 3 patients, two antigens in 14 patients, and three antigens in 9 patients. All patients were prepared with a regimen consisting of total body irradiation, etoposide, cytosine arabinoside, cyclophosphamide and methylprednisolone. All marrows were treated ex vivo with T10B91.A-31, a monoclonal antibody directed toward the alpha beta heterodimer of the CD3 receptor, and rabbit complement. Additional GVHD prophylaxis included either the anti-CD5 immunoconjugate XomaZyme-H65, cyclosporine, or both in combination with methylprednisolone. Eight patients did not have sustained engraftment. The 100-day survival was 42%. The incidence of > or = grade II acute GVHD was 29%. The incidence of chronic GVHD was 50% and was limited in all cases. The median survival at 4 years for all 26 patients was 27%. Seven patients (CP 1, AP 3, BC 3) remain in hematologic remission 1297-2241+ days after transplantation. AlloBMT from a PMRD may be considered for patients with advanced CML who lack a matched sibling or unrelated donor.
Department of Internal Medicine, University of Kentucky Medical Center, Lexington, USA.
M R
MR
Bishop
P J
PJ
Henslee-Downey
J R
JR
Anderson
E H
EH
Romond
E
E
Marciniak
R
R
Yankey
M
M
Reeves
J S
JS
Thompson
D000293:Adolescent; D000328:Adult; D000818:Animals; D001752:Blast Crisis / Q000401:mortality / Q000628:therapy; D016465:Bone Marrow Purging; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000276:immunology; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control; D006680:HLA Antigens; D006239:Haplotypes; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D015465:Leukemia, Myeloid, Accelerated Phase / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011817:Rabbits; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
D006680:HLA Antigens