Graft-versus-leukemia effect in allogeneic marrow transplant recipients with acute leukemia is maintained using cyclosporin A combined with methotrexate as prophylaxis

O. Ringdén, M. Labopin, E. Gluckman, J. Reiffers, J. P. Vernant, J. P. Jouet, J. L. Harrousseau, D. Fiere, A. Bacigalupo, F. Frassoni, N. C. Gorin

Research output: Contribution to journalArticle

Abstract

A total of 1634 recipients of HLA-identical sibling bone marrow with acute leukemia were treated with the combination of cyclosporin A (CsA) and methotrexate as prophylaxis against graft-versus-host disease (GVHD). The probability of relapse decreased with an increasing grade of acute GVHD, especially in patients grafted in first remission (CR-1): P <0.01 and P <0.0011 for acute lymphoblastic leukemia and acute myeloid leukemia, respectively. Among patients surviving at least 3 months without a relapse, chronic GVHD was associated with a decreased incidence of relapse in CR-1 (P <0.0001 for both diagnoses), and a better LFS. Among patients in CR-1, the probability of relapse was the same in those with limited or with extensive chronic GVHD. However, in patients with intermediate stage of the disease (≤ 2nd remission or 1st relapse) with previous acute GVHD, those with extensive chronic GVHD had a reduced probability of relapse (P = 0.05). The graft-versus-leukemia effect of acute and especially chronic GVHD was confirmed by multivariate analyses. Overall, the highest LFS was seen in patients with chronic GVHD and no or grades I-II acute GVHD. The lowest LFS was seen in patients having acute GVHD grades III-IV without chronic GVHD.

Original languageEnglish
Pages (from-to)921-929
Number of pages9
JournalBone Marrow Transplantation
Volume18
Issue number5
Publication statusPublished - Nov 1996

Keywords

  • Cyclosporin A
  • GVL
  • Methotrexate

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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