Summary
Bone marrow transplantation was performed between IV/82 and X/85 in 64 patients with acute leukemia (n=36), chronic myelogenous leukemia (CML;n=13), severe aplastic anemia (n=12), and neuroblastoma stage IV (n=3). Of these patients 57 received allogeneic marrow from HLA-ABCDR identical, MLC-negative sibling donors. Six transplants were performed with syngenic marrow and one with autologous marrow. Of the 64 patients 48 survived 40-1,250 days after transplantation, resulting in a survival rate (SR) of 75% and a survival probability (SP) of 71%. Of the 36 patients suffering from acute leukemia (SR=64%, SP=51%), patients with acute myelogenous leukemia (AML) in first complete remission (n=11; SR=81%, SP=76%), as well as patients with acute lymphatic leukemia (ALL) in 1st to 4th complete remission at the time of transplantation (n=14; SR=81%, SP=76%) show a favorable prognosis. A poor survival rate was seen for patients with AML when transplanted in second or partial remission (1/5; SR=20%), as well as for patients suffering from ALL and transplanted during relapse or partial remission (1/6; SR=16%). Of 13 patients suffering from CML 12 survived the transplantation free of relapse (SR=93%, SP=92%), and one patient died from varicella zoster pneumonia. Of the transplanted patients with severe aplastic anemia, 12 of 13 are surviving with complete hematologic reconstitution; one patient, however, died on day 10 from a sepsis. In our patient group, the SR as well as the SP has been improved through changes in the irradiation protocol concomitant with prophylactic application of anti-CMV hypergammaglobulin, as well as through additional oral medication of Azyklovir. The 41 patients (BMT No. 7–47) with total body irradiation at one time-show an SR of 44% and an SP of 41%. The following 46 patients (BMT No. 48–93) have reached an SR of 83% and an SP of 74% under the regimen of fractionated total body irradiation, plus prophylaxis with anti-CMV hypergammaglobulin and Azyklovir. Within this group, no fatal CMV pneumonia was encountered as opposed to six patients lost from CMV pneumonia in the first group.
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Abbreviations
- AHTCG:
-
Anti-human-T-cell-globulin
- ALL:
-
Akute lymphatische Leukämie (acute lymphatic leukemia)
- AML:
-
Akute myeloische Leukämie (acute myelogenous leukemia)
- ANV:
-
Akutes Nierenversagen
- ARA-C:
-
Cytosin-Arabinosid
- ARDS:
-
Akutes respiratorisches Distress-Syndrom
- ATG:
-
Antithymozytenglobulin
- CML:
-
Chronisch myeloische Leukämie (chronic myelogenous leukemia)
- CMV:
-
Cytomegalievirus (cytomegalic virus)
- CsA:
-
Cyclosporin A
- Ext.:
-
Extensive Form
- GKB:
-
Ganzkörperbestrahlung
- GvHD:
-
Graft-versus-Host-Erkrankung
- HLA:
-
Human leukocyte antigen
- HUS:
-
Hämolytisch-urämisches Syndrom
- IP:
-
Idiopathische interstitielle Pneumonie
- KMT:
-
Knochenmarktransplantation
- Lim.:
-
Limitierte Form
- MLC:
-
Mixed lymphocyte culture
- Mtx:
-
Methotrexat
- OPSI:
-
Overwhelming-postsplenectomy-syndrome
- SAA:
-
Schwere aplastische Anämie
- SP:
-
Survival probability
- SR:
-
Survival rate
- TR:
-
Teilremission
- ÜR:
-
Überlebensrate
- ÜW:
-
Überlebenswahrscheinlichkeit
- VR:
-
Vollremission
- VZV:
-
Varizella-Zoster-Virus
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Herrn Prof. Dr. H.D. Waller zum 60. Geburtstag gewidmet
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Ostendorf, P., Ehninger, G., Dopfer, R. et al. Knochenmarktransplantation bei akuter Leukämie, chronisch myeloischer Leukämie, schwerer aplastischer Anämie und Neuroblastom Stadium IV. Einfluß antiviraler Prophylaxe mit Anti-CMV-Hyperimmunglobulin und Azyklovir. Klin Wochenschr 64, 452–466 (1986). https://doi.org/10.1007/BF01713171
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DOI: https://doi.org/10.1007/BF01713171