Cyclosporin-A in allogeneic bone marrow transplantation for leukemia: Basle experience 1979 to 1984

Since July 1979 all patients transplanted in Basle have been treated with Cyclosporin-A (CyA) as prophylaxis against Graft-versus-Host-Disease (GvHD). Currently CyA is given as a continuous infusion for 3-4 weeks, followed by an oral once-daily-therapy for one year. The daily dose is adjusted depending on the serum creatinine. Patients with acute GvHD during CyA therapy are treated with high dose bolus-steroid therapy. 83 patients with leukemia were treated in these 5 years. All were conditioned with 2 X 60 mg/kg Cyclophosphamide and 10 Gy total body irradiation. 78 had an HLA-identical, 5 an HLA-haploidentical family donor. The median age is 28 years (5-42 y). 20 patients had AML in 1. CR, 9 patients AML not in 1. CR (2nd, 3rd CR or relapse), 11 ALL in 1. CR, 19 not in 1. CR, 20 CML in chronic and 4 CML in accelerated phase. 40 patients are actually alive, well and without any signs of their disease; 9 are living in relapse. Major cause of death is relapse and GvHD. CyA does not reduce the incidence, it does reduce the severity of GvHD. The only long-term side-effects of bone marrow transplantation seen are cataracts and sterility. The major factors influencing outcome is the time of transplant. 31/51 patients transplanted in 1. CR or in chronic phase of CML are alive compared to only 9/32 transplanted in later stages. We conclude that bone marrow transplantation should be performed early in the disease and that CyA eases the procedure.