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Factors affecting survival in allogeneic bone marrow transplantation
W R Vogler1, E F Winton, R C Reynolds
1Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30322.
The American Journal of the Medical Sciences
|May 1, 1989
Summary
Bone marrow transplants (BMT) show varied success rates for different leukemias and aplastic anemia. Graft-versus-host disease (GVHD) significantly impacts survival, but prophylactic measures like methotrexate and cyclosporine can reduce its incidence.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Bone marrow transplantation (BMT) is a critical therapeutic option for various hematologic malignancies and aplastic anemia.
- Patient outcomes following BMT are influenced by disease type, phase at transplant, and post-transplant complications.
- Graft-versus-host disease (GVHD) and interstitial pneumonia (IP) are significant causes of morbidity and mortality after allogeneic BMT.
Purpose of the Study:
- To analyze the outcomes of allogeneic and syngeneic bone marrow transplants performed between 1979 and 1988.
- To identify factors influencing survival, including disease type, transplant phase, GVHD, and prophylactic treatments.
- To evaluate the impact of interventions on complications like GVHD and IP.
Main Methods:
- Retrospective analysis of 82 allogeneic and 2 syngeneic BMTs in 78 patients with diagnoses including AML, ALL, CML, MDS, MM, HD, DPDL, and AA.
- Univariant analyses were performed to identify prognostic factors.
- Evaluation of GVHD incidence and mortality, and the effect of methotrexate (MTX) plus cyclosporine (CSP) prophylaxis.
- Assessment of IP frequency and mortality, and the impact of acyclovir and intravenous gamma globulin.
Main Results:
- Survival rates varied by diagnosis: AML (63% in remission), CML (40% in chronic phase, 22% in advanced phases), and aplastic anemia (62%).
- ALL patients had poor outcomes, especially those transplanted in relapse.
- GVHD was associated with increased mortality (73% vs. 55% without GVHD). MTX+CSP reduced GVHD incidence to 23% compared to 58%.
- Interstitial pneumonia was highly fatal (15/16 cases). Introduction of acyclovir and IVIG showed minimal reduction in IP frequency but significantly increased overall survival from 21% to 47%.
Conclusions:
- BMT outcomes are highly dependent on the underlying hematologic condition and disease status at the time of transplant.
- Effective GVHD prophylaxis, such as using methotrexate and cyclosporine, is crucial for improving patient survival.
- While interventions had limited impact on IP, overall survival improvements suggest evolving supportive care strategies in BMT.