[Study on graft-versus-host disease in the allogeneic peripheral blood stem cell transplantation for the treatment of leukemia].
OBJECTIVE
To analyze the incidence and the effective prevention and treatment of graft-versus-host disease (GVHD) for the allogeneic peripheral blood stem cell transplantation (allo-PBSCT) for the treatment of leukemia.


METHODS
Fifty patients with acute leukemia (n = 29) and chronic myeloid leukemia (n = 21) were treated with allo-PBSCT. The conditioning regimens were TBI plus CTX and Vp16 or TBI plus CTX. Two regimens were used for prophylaxis of GVHD: one was the combination of low dose cyclosporine (CsA, 2 - 3 mg x kg(-1) x d(-)1 i.v. or 4 - 6 mg x kg(-1) x d(-1) p.o.) and short course methotrexate (MTX, 15 approximately 10 mg, +1, +3, +6, +11 d) (CsA/MTX group, 32 patients), the other was short course of mycophenolate mofetil (MMF, 1.0 bid, +1 - +28 d) in addition to CsA and MTX (MMF/CsA/MTX group, 18 patients).


RESULTS
All patients were successfully engrafted and the median times to ANC > 0.5 x 10(9)/L and to platelet > 20 x 10(9)/L were 14 (10 - 22) and 20 (10 - 68) days post PBSCT respectively. The incidence of acute GVHD (aGVHD) was 40% (20/50) and of grade III - IV was 12% (6/50). The chronic GVHD (cGVHD) occurred in 22 out of 33 (66.7%) evaluable patients (survived longer than 6 months post PBSCT) and extensive cGVHD in 11 out of 33 (33.3%) patients. Patients with aGVHD displayed significantly higher sIL-2R levels [(277.3 +/- 26.4) U/L] and CD(25)(+) cells [(8.1 +/- 3.4)%] than those without GVHD [(128.1 +/- 96.7) U/L and (3.6 +/- 1.7)%] (P < 0.05). The incidences of aGVHD (16.7%) and extensive cGVHD (9.1%) in MMF/CsA/MTX group were significantly lower than that in CsA/MTX group (53.1% and 45.5%, P < 0.05). The median follow-up duration was 30 (3 - 70) months and 33 patients were still alive. The relapse rate was significantly higher in GVHD negative group (47.1%) than in GVHD positive group (0, P < 0.05). The 3 year disease-free-survival (DFS) rate was 66%.


CONCLUSIONS
The incidence of aGVHD was low, but of cGVHD was high in allo-PBSCT. sIL-2R and CD(25)(+) cells after PBSCT may provide predictive markers for aGVHD. The MMF/CsA/MTX regimen for prevention of aGVHD in allo-PBSCT is more effective than the CsA/MTX one. There was a strong antileukemic effect of GVHD in the allo-PBSCT.
Zhang
Wei-ping
WP
Department of Hematology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
Wang
Jian-min
JM
Ju
Xiao-ping
XP
Song
Xian-min
XM
Tong
Shu-peng
SP
Li
Hong-mei
HM
D000293:Adolescent; D000328:Adult; D016572:Cyclosporine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007938:Leukemia / Q000628:therapy*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous / Q000009:adverse effects
D004791:Enzyme Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D008727:Methotrexate