Encouraging preliminary results in 12 patients with high-risk haematological malignancies by omitting graft-versus-host disease prophylaxis after allogeneic transplantation.
Immunosuppressive therapy, routinely given after allogeneic transplantation to modulate graft-versus-host disease (GVHD) may have an adverse effect on the graft-versus-tumour (GVT) effect. Twelve patients with high-risk haematological malignancies were given cyclophosphamide, total body irradiation and antithymocyte globulin followed by peripheral blood stem cell grafts from HLA-identical siblings without prophylactic immunosuppression. At the earliest clinical evidence of GVHD, patients were treated with high-dose solumedrol and tacrolimus. Prompt haematological recovery [absolute neutrophil count (ANC) > 1.0 x 109/l] was observed (median time 9 d). All patients developed grade III-IV GVHD (median onset 9 d), involving the skin (11), intestine (five) and liver (three). Of nine evaluable patients, seven developed chronic GVHD [extensive (six), limited (one)]. Six patients died 1-6.5 months after transplantation. Three patients died from treatment-related complications, two from acute GVHD and one from relapsing disease. The remaining six patients are alive 5-26 months after transplantation, five in complete remission and one myeloma patient in very good partial remission. In conclusion, omission of post-transplantation GVHD prophylaxis is feasible, does not lead to graft failure or a high incidence of uncontrollable GVHD and appears to be associated with encouraging clinical responses in a group of patients with high-risk disease features.
Fassas
A B
AB
Bone Marrow Transplant Program, Department of Internal Medicine, University of Maryland, Baltimore, MD, USA.
Rapoport
A P
AP
Cottler-Fox
M
M
Chen
T
T
Tricot
G
G
D000208:Acute Disease; D000328:Adult; D016026:Bone Marrow Transplantation; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000188:drug therapy; D020350:Graft vs Tumor Effect; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000276:immunology / Q000601:surgery*; D007951:Leukemia, Myeloid / Q000276:immunology / Q000601:surgery*; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000276:immunology / Q000601:surgery; D016393:Lymphoma, B-Cell / Q000276:immunology / Q000601:surgery*; D020522:Lymphoma, Mantle-Cell / Q000276:immunology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000276:immunology / Q000601:surgery; D010865:Pilot Projects; D011241:Prednisone / Q000627:therapeutic use; D014184:Transplantation, Homologous
D005938:Glucocorticoids; D011241:Prednisone