Clinical transplantation
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Clinical transplantation · Jun 1994
Prognostic factors for long-term survival in leukemic marrow recipients with special emphasis on age and prophylaxis for graft-versus-host disease.
Long-term survival of 182 leukemic patients after allogeneic bone marrow transplantation (BMT) was analyzed retrospectively regarding the type of graft-versus-host disease (GvHD) prophylaxis and patient age. Monotherapy with either methotrexate (MTX) (n = 59) or cyclosporin (CSA) (n = 40) was given to 79 patients less than 30 years of age and to 20 older patients. These patients were compared to those receiving a combination of MTX+CSA (n = 55) or T-cell depletion (TCD) (n = 28) (38 patients < or = 30 and 45 > 30 years of age). ⋯ Using monotherapy, in contrast to combination therapy or TCD, multivariate analysis showed that recipient age > 30 years and HLA disparity between donor and recipient were correlated with poor outcome. In patients receiving MTX + CSA or TCD, a female donor to a male recipient correlated significantly with poor survival, which was not the case with monotherapy. Disease status beyond 1st complete remission (1 CR) or 1st chronic phase (1 CP), grade II-IV acute GvHD and recipient CMV seropositivity were significant risk-factors among all patients regardless of the type of GvHD prophylaxis.