Summary:This study investigated the response rate and toxicity of blood cell transplantation as treatment for primary amyloidosis (AL). Twenty-three patients had stem cells collected between November 1995 and September 1998. Conditioning included melphalan and total body irradiation in 16 and melphalan alone in 4. Three patients did not undergo stem cell infusion because of poor performance status. Two died of progressive amyloid at 1 and 3 months. One patient is alive on hemodialysis. Fourteen males and six females (median age, 57 years) underwent transplantation. Renal, cardiac (by echocardiography), peripheral neuropathy or liver amyloidosis occurred in 14, 12, 3, and 1, respectively. Echocardiography demonstrated an interventricular septal thickness у15 mm in six patients, five of whom died post transplantation. Three patients died of progressive amyloidosis at 7, 7, and 21 months. Thirteen patients are alive with a follow-up of 3 to 26 months. Twelve (60%) fulfilled the criteria of a hematologic or organ response. Severe gastrointestinal tract toxicity was seen in five (25%). We conclude that blood cell transplantation for amyloidosis had a much higher morbidity and mortality compared with transplantation for myeloma. The best results appear to occur in patients with nephrotic syndrome as the only manifestation of their disease. Bone Marrow Transplantation (2000) 26, 963-969.

Summary:To determine the effect of two different graft-versushost disease (GVHD) prophylactic regimens -cyclosporine with short course of methotrexate (CYA-MTX) and cyclosporine with prednisone (CYA-PRED) -on the incidence of chronic GVHD (cGVHD), we retrospectively reviewed the outcomes of 196 consecutive allogeneic related blood and marrow transplants performed at our institution utilizing one of these regimens. CYA-PRED was given to patients who were transplanted more recently because of concern about the increased risk of veno-occlusive disease of the liver, increased mucositis, and slower engraftment in patients receiving CYA-MTX. Prophylaxis with CYA-PRED was associated with a higher risk of development of cGVHD (risk ratio (RR) 3.5; 95% confidence intrerval (CI), 2.2-5.4). The proportion of patients with extensive disease among those developing cGVHD was higher in the CYA-PRED group (71%) than in the CYA-MTX group (57%), although this difference was not statistically significant. The cumulative probability of extensive cGVHD at 2 years was higher in the CYA-PRED group (RR 4.2, 95% CI, 2.4-7.4). Development of acute GVHD and cytomegalovirus mismatch were independent predictors of increased risk of cGVHD. We conclude that GVHD prophylaxis with CYA-PRED is associated with a higher overall rate of cGVHD compared to CYA-MTX. The type of GVHD prophylaxis should be considered when comparing the incidence of cGVHD reported in different studies. Bone Marrow Transplantation (2001) 27, 1133-1140. Keywords: allogeneic bone marrow transplantation; CYA; cytomegalovirus; MTX; prednisone; survival The number of allogeneic bone marrow transplantations (BMT) has increased steadily over the past three decades. 1 BMT offers the potential for cure in many hematologic malignancies. Graft-versus-host disease (GVHD), both acute and chronic, is an important complication of allogeneic transplants. Moderate-to-severe GVHD occurs in as many as one-half of the recipients of HLA-identical sibling transplants despite post-transplantation prophylaxis of GVHD. 2 Chronic GVHD develops in a significant number of these patients. For patients who survive the initial 2 to 3 months after transplantation, development of chronic GVHD has the greatest effect on their subsequent quality of life. The incidence of chronic GVHD reported in previous studies varied from 30% to 60%. 3,4 GVHD alone or in combination with infection accounts for a significant number of late transplant-related deaths in patients free of disease.Severe acute GVHD has a high mortality rate, and its prevention remains a cornerstone in the management of patients who have received a transplant. Considerable controversy exists about how best to prevent acute GVHD, and various pharmacologic and nonpharmacologic modalities have been tried. In vitro depletion of T lymphocytes from the marrow has been associated with a decreased incidence of GVHD, but it contributes to a higher rate of relapse and graft failure. 5 Various immunosuppressive drugs, alone or in combination, have been us...

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