Intensification of the Conditioning Regimen for Allogeneic Bone Marrow Transplantation in Recipients of T-cell Depleted Grafts by the Addition of Anthracyclines

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Abstract
T-cell depletion of bone marrow reduces the incidence and severity of graft-versus-host-disease but is associated with a higher probability of relapse. We added anthracyclines to the conditioning regimen in order to reduce the relapse-rate. Fifty-two consecutive standard-risk recipients of a genotypically identical graft received additional daunorubicin 156mg/m2 (n = 10) or Idarubicin 42mg/m2 (n = 42) between day -8 and -1. In the patients who received anthracyclines, the probabilities of relapse and disease-free survival were 18% and 60% respectively, during a follow-up of 24 to 66 (median 42) months. These results are significantly better than those obtained in an earlier cohort of 35 comparable patients treated with the standard conditioning regimen only (p<0.05). Patients in the anthracycline group almost universally had severe but transient oromucositis, but overall, the regimen was tolerated well.