title: Leukemia-free survival and mortality in patients with refractory or relapsed acute leukemia given marrow transplants from sibling and unrelated donors.
abstract: Between April 1982 and February 1997 39 patients (24 male, 15 female) with refractory acute leukemia and a median age of 31 years (19-51 years) received allogeneic marrow grafts from an HLA-identical sibling (n = 27), HLA-identical unrelated donor (MUD; n = 10) or 1-antigen mismatched unrelated donor (n = 2). Twenty-eight patients had acute myelogenous leukemia and 11 acute lymphoblastic leukemia. For conditioning most patients received total body irradiation combined with cyclophosphamide (n = 23) or etoposide (n = 7). For graft-versus-host disease prophylaxis patients received cyclosporin A (CsA) and methotrexate (MTX) (n = 20), MTX alone (n = 3), CsA and methylprednisone (n = 6), or CsA alone (n = 10), respectively. As of June 1997 probability of leukemia-free survival projected to 3 years after BMT was 14% for patients given sibling marrow grafts and 28% after MUD transplantation. Transplant-related mortality projected to 3 years was 32% after sibling and 37% after MUD marrow grafting. Although not significantly different, probability of relapse projected to 3 years after BMT was lower after MUD at 56% compared to 78% with sibling BMT. Thus, high-dose chemo/radiotherapy followed by allogeneic marrow infusion has a curative potential for patients with refractory leukemia and offers the chance of long-term disease-free survival for some patients.
authors.affiliation: Department of Medicine I, University of Vienna, Austria.
authors.forename: H T
authors.initials: HT
authors.lastname: Greinix
authors.forename: E
authors.initials: E
authors.lastname: Reiter
authors.forename: F
authors.initials: F
authors.lastname: Keil
authors.forename: G
authors.initials: G
authors.lastname: Fischer
authors.forename: K
authors.initials: K
authors.lastname: Lechner
authors.forename: K
authors.initials: K
authors.lastname: Dieckmann
authors.forename: G
authors.initials: G
authors.lastname: Leitner
authors.forename: A
authors.initials: A
authors.lastname: Schulenburg
authors.forename: P
authors.initials: P
authors.lastname: Hoecker
authors.forename: O A
authors.initials: OA
authors.lastname: Haas
authors.forename: P
authors.initials: P
authors.lastname: Knoebl
authors.forename: C
authors.initials: C
authors.lastname: Mannhalter
authors.forename: C
authors.initials: C
authors.lastname: Fonatsch
authors.forename: W
authors.initials: W
authors.lastname: Hinterberger
authors.forename: P
authors.initials: P
authors.lastname: Kalhs
mesh_terms: D000208:Acute Disease; D000328:Adult; D016026:Bone Marrow Transplantation; D018572:Disease-Free Survival; D005260:Female; D006650:Histocompatibility Testing; D006801:Humans; D007938:Leukemia / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014019:Tissue Donors; D014184:Transplantation, Homologous