[Unrelated donor allogenetic marrow transplantation in treatment of acute and chronic leukemia]

Abstract

Objective: To evaluate the clinical efficacy against acute and chronic leukemia of unrelated donor allogenetic marrow transplantation (URD-BMT) and to develop methods of preventing and treating complications of URD-BMT.

Methods: Eleven patients, 2 with acute lymphatic leukemia, 2 with acute myelocytic leukemia, and 7 with chronic myelocytic leukemia, were treated by URD-BMT. The median age of the 11 patients, 6 male and 5 females, were 26 years. The conditioning regimen for 10 patients was: BU 4 mg.kg(-1).d(-1) x 4 + CTX 60 mg.kg(-1).d(-1)1 x or TBI 7.5 Gy + CTX 60 mg.kg(-1).d(-1) x 2. Bone marrow with karyocytes in the dose of (2.6 approximately 4.8) x 10(8)/kg, including CD34+ cells in the dose of (3.82 approximately 12.8) x 10(6)/kg, and with the CFU-CM in the dose of (1.71 approximately 3.68) x 10(5)/kg, were transfused. Mycophenolate mofitil, cyclosporine, and methotrexate were given to prevent acute graft-versus-host disease (aGVHD). Continuous intravenous drip of heparin in low dose with Lipo protaglandin E1 was given to prevent hepatic veno-occlusive disease (VOD). Ganciclovir was used to prevent CMV infection. HLA phenotype was matched in 8 cases, mismatched in one locus in 2 cases, and mismatched in 2 loci in one case.

Results: Hematopoietic reconstruction was successful in all of the patients with the neutrophil count of 0.5 x 10(9)/L on the 10th day after transplantation and the platelet count of more than 20 x 10(9)/L on the 27(th) day. Analysis of DNA short series repeated sequence polymorphism showed the survival of bone marrow after transplantation in ten cases. One case of IV grade aGVHD, one case of II grade aGVHD, one case of serious VOD and III grade artrioventricular block, three cases of hemorrhagic cystitis, and one case of interstitial pneumonia occurred, the last case being died. Recurrence of leukemia occurred in one case seven months after the transplantation. That case was given the transfusion of donor's lymphocytes and has been so far under treated. Ten cases are alive in disease-free situation till now.

Conclusion: URD-BMT is an effective method for the treatment of acute and chronic leukemia. The prophylaxis regimen against aGVHD, VOD, and CMV that we use is effective and safe.