A prospective randomised trial of cyclosporin versus methotrexate after HLA-identical sibling marrow transplantation for patients with acute leukemia in first remission: analysis 2.5 years after last patient entry.

The results of a prospective randomised trial comparing cyclosporin (CSP) with methotrexate (MTX) as immunosuppressive therapy after HLA-identical sibling marrow transplantation for patients with acute leukemia in first remission were analysed 2.5 years after entry of the last patient into the trial. Patients given cyclosporin showed a faster rate of marrow engraftment, less oro-pharyngeal mucositis, more azotemia and more diastolic hypertension than those receiving methotrexate. Actuarial four-year survival was 69% for patients receiving MTX and 43% for those receiving cyclosporin (not significant). Actuarial four-year survival in continuous complete remission from the time of transplant was 69% and 38% respectively (not significant, p = 0.09). While there was no difference in the incidence or severity of acute or chronic graft-versus-host disease, the actuarial rate of leukemic recurrence was 0% in the MTX and 36% in the GSP group (p = 0.02). This finding emphasises the importance of long-term follow up for the full assessment of new therapeutic protocols of marrow transplantation in the treatment of hematological malignancy.

[1]  K. Atkinson,et al.  Avascular necrosis of the femoral head secondary to corticosteroid therapy for graft-versus-host disease after marrow transplantation: effective therapy with hip arthroplasty. , 1987, Bone marrow transplantation.

[2]  K. Atkinson,et al.  Late onset transfusion-dependent anaemia with thrombocytopenia secondary to marrow fibrosis and hypoplasia associated with chronic graft-versus-host disease. , 1987, Bone marrow transplantation.

[3]  J. Biggs,et al.  The development of the acquired immunodeficiency syndrome after bone-marrow transplantation. , 1987, The Medical journal of Australia.

[4]  J. Biggs,et al.  A comparative study of T-cell depleted and non-depleted marrow transplantation for hematological malignancy. , 1987, Australian and New Zealand journal of medicine.

[5]  J. Biggs,et al.  The impact of leukemia status at the time of HLA-identical sibling marrow transplantation on subsequent complication rate and survival of adults with acute leukemia. , 1986, Australian and New Zealand journal of medicine.

[6]  R. Marcus,et al.  Bone marrow transplantation for patients with chronic myeloid leukaemia: T-cell depletion with Campath-1 reduces the incidence of graft-versus-host disease but may increase the risk of leukaemic relapse. , 1986, Bone marrow transplantation.

[7]  G. Gahrton,et al.  A randomized trial comparing use of cyclosporin and methotrexate for graft-versus-host disease prophylaxis in bone marrow transplant recipients with haematological malignancies. , 1986, Bone marrow transplantation.

[8]  J. Biggs,et al.  A randomized prospective trial comparing cyclosporine and methotrexate given for prophylaxis of graft-versus-host disease after bone marrow transplantation. , 1986, Transplantation proceedings.

[9]  Kennedy,et al.  Marrow transplantation for chronic myelocytic leukemia: a controlled trial of cyclosporine versus methotrexate for prophylaxis of graft-versus-host disease. , 1985, Blood.

[10]  Kennedy,et al.  Cyclosporine as prophylaxis for graft-versus-host disease: a randomized study in patients undergoing marrow transplantation for acute nonlymphoblastic leukemia. , 1985, Blood.

[11]  P. Neiman,et al.  Donor cell leukemia developing six years after marrow grafting for acute leukemia. , 1985, Blood.

[12]  H. Deeg,et al.  Marrow transplantation for leukemia following fractionated total body irradiation. A comparative trial of methotrexate and cyclosporine. , 1985, Leukemia research.

[13]  J. Hermans,et al.  Bone marrow transplantation for acute lymphoblastic leukaemia: a survey of the European Group for Bone Marrow Transplantation (E.G.B.M.T.) , 1984, British journal of haematology.

[14]  K. Lafferty,et al.  Inhibition of T‐Cell Activity by Cyclosporin A , 1982, Scandinavian journal of immunology.

[15]  K. Sullivan,et al.  Chronic graft-versus-host disease in 52 patients: adverse natural course and successful treatment with combination immunosuppression. , 1981, Blood.

[16]  K. Sullivan,et al.  Chronic graft-versus-host syndrome in man. A long-term clinicopathologic study of 20 Seattle patients. , 1980, The American journal of medicine.

[17]  P. Neiman,et al.  One hundred patients with acute leukemia treated by chemotherapy, total body irradiation, and allogeneic marrow transplantation. , 1977, Blood.

[18]  R. Storb,et al.  Histopathology of graft-vs.-host reaction (GvHR) in human recipients of marrow from HL-A-matched sibling donors. , 1974, Transplantation proceedings.

[19]  P. Neiman,et al.  CLINICAL MANIFESTATIONS OF GRAFT‐VERSUS-HOST DISEASE IN HUMAN RECIPIENTS OF MARROW FROM HL‐A-MATCHED SIBLING DONOR,S , 1974, Transplantation.

[20]  E. Kaplan,et al.  Nonparametric Estimation from Incomplete Observations , 1958 .