title: Influence of graft-versus-host disease on outcome following allogeneic transplantation with radiation-free preparative therapy in patients with advanced leukemia.
abstract: Between March 1984 and March 1995, 76 patients with advanced acute myelogenous, acute lymphoblastic, or chronic myelogenous leukemia underwent allogeneic marrow transplantation from HLA-identical or one-antigen mismatched sibling or unrelated donors. Patients received a preparative regimen consisting of busulfan 16 mg/kg and cyclophosphamide 120 mg/kg or busulfan 14 mg/kg, cyclophosphamide 120 mg/kg and etoposide (VP-16) 50 mg/kg. For GVHD prevention, patients received cyclosporine with either methotrexate or steroids or FK506 with methotrexate. Fourteen patients were leukemia-free survivors at a median of 6.5 years (range 1-11 years) following transplantation. For the group as a whole, the estimated leukemia-free survival (LFS) at 5 years is 20% (95% confidence interval 10-30%). Ten of the 14 leukemia-free survivors developed acute GVHD greater than grade II and chronic GVHD and two developed only chronic GVHD. Significantly better relapse rates and disease-free survival were associated with the development of acute and/or chronic GVHD. In the absence of acute GVHD and/or chronic GVHD, patients who underwent transplantation for advanced leukemia, after preparation with Bu/CY or Bu/CY/VP-16, were very likely to experience disease recurrence. Novel strategies designed to promote development of GVHD present a promising area for investigation to improve outcome in patients with leukemia at high risk for relapse.
authors.affiliation: Division of Bone Marrow Transplantation, Ohio State University, Arthur G James Cancer Hospital and Research Institute, Columbus 43210, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Copelan
authors.forename: S L
authors.initials: SL
authors.lastname: Penza
authors.forename: P J
authors.initials: PJ
authors.lastname: Elder
authors.forename: P S
authors.initials: PS
authors.lastname: Belt
authors.forename: M D
authors.initials: MD
authors.lastname: Scholl
authors.forename: D M
authors.initials: DM
authors.lastname: Hehmeyer
authors.forename: S A
authors.initials: SA
authors.lastname: Ezzone
authors.forename: T P
authors.initials: TP
authors.lastname: Bechtel
authors.forename: B R
authors.initials: BR
authors.lastname: Avalos
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002066:Busulfan / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D006086:Graft vs Host Disease / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007938:Leukemia / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D005047:Etoposide; D003520:Cyclophosphamide; D002066:Busulfan