After organ transplantation, life-long immunosuppression is mandatory to prevent rejection. This is not the case after allogeneic bone marrow transplantation (BMT). The mechanisms of tolerance are little understood and there is little data about the required duration of immunosuppression. In a retrospective study we analyzed the use of cyclosporine A (CyA) treatment in all BMT patients who where transplanted in Basel from 1979 to 1991. 243 patients with a median age of 26 (2-49) years received CyA to prevent graft-versus-host-disease (GVHD) and rejection. 206 patients had leukemia, 26 severe aplastic anemia and 10 a lymphoproliferative disorder. All were treated according to a common CyA regimen with initial parenteral administration followed by oral treatment for a year; after 1988 treatment duration was reduced to 6 months. Drug dosage was adjusted according to clinical symptoms, plasma levels and toxicity. At relapse of the original disease CBA was always withdrawn. Three months after BMT 96% were still on CyA. After 6 months 79%, after 1 year 61%, after 2 years 29%, after 3 years 18%, after 4 years 15%, after 5 years 8% and after 8 years 2% of patients were still taking CyA. All 20 patients who are still alive 10 years after BMT are off CBA. CyA was administered parenterally for a median of 31 (5-147) days. Oral treatment started at day 25 (4-28). The oral dose was reduced 5 (1-20) times, increased once (1-75) and finally discontinued after a median time lapse of 1 year (14d-8y). The most prominent side effect was an elevation in serum creatinine from 75 (20-187) mu mol/l to 130 (46-600) mu mol/l three months after BMT After one year the creatinine values had improved to 97 (38-128) mu mol/l and after four years to 92 (43-145) mu mol/l. The increase in serum creatinine did not change during the whole observation period in spite of a reduction of the initial CyA dose from 20 mg/kg to 5 mg/kg and therefore a reduction of the CyA plasma level at day 20 from 740 (60-3403) ng/ml to 411 (183-981) ng/ml. These data show that 2 years after BMT only 30% and after 5 years only 8% of patients require immunosuppression with CyA. We therefore believe an attempt to omit CyA after three months in patients without GVHD, and once yearly in those who require CyA for a longer period, is justified.

After organ transplantation, life-long immunosuppression is mandatory to prevent rejection. This is not the case after allogeneic bone marrow transplantation (BMT). The mechanisms of tolerance are little understood and there is little data about the required duration of immunosuppression. In a retrospective study we analyzed the use of cyclosporine A (CyA) treatment in all BMT patients who where transplanted in Basel from 1979 to 1991. 243 patients with a median age of 26 (2-49) years received CyA to prevent graft-versus-host-disease (GvHD) and rejection. 206 patients had leukemia, 26 severe aplastic anemia and 10 a lymphoproliferative disorder. All were treated according to a common CyA regimen with initial parenteral administration followed by oral treatment for a year; after 1988 treatment duration was reduced to 6 months. Drug dosage was adjusted according to clinical symptoms, plasma levels and toxicity. At relapse of the original disease CyA was always withdrawn. Three months after BMT 96% were still on CyA. After 6 months 79%, after 1 year 61%, after 2 years 29%, after 3 years 18%, after 4 years 15%, after 5 years 8% and after 8 years 2% of patients were still taking CyA. All 20 patients who are still alive 10 years after BMT are off CyA. CyA was administered parenterally for a median of 31 (5-147) days. Oral treatment started at day 25 (4-28). The oral dose was reduced 5 (1-20) times, increased once (1-75) and finally discontinued after a median time lapse of 1 year (14d-8y).(ABSTRACT TRUNCATED AT 250 WORDS)

Since October 1988 there has been an isolation ward at Basle Cantonal Hospital. Its purpose is to treat patients with high dose chemotherapy and bone marrow transplantation under protective isolation and by standardized criteria. The isolation ward has two sub-units, viz. the reverse isolation for neutropenic patients (8 single room units) and the LAF unit (5 laminar airflow units) for allogeneic bone marrow transplantation (BMT). Up to July 1992, 287 patients (152 males and 133 females) required 527 hospitalizations. The median age was 41 (5-82) years in the reverse isolation unit and 28 (4-61) years in the LAF unit. Bed occupation was 90% and 82% throughout the period. 71% of patients were from the Basle area and the rest from elsewhere in Switzerland or from other countries. Diagnosis: acute leukemias (112); myelodysplastic or myeloproliferative syndromes (52); severe aplastic anemia or agranulocytosis (46); lymphoproliferative syndromes (50); solid tumors (28). Indications for hospitalisation: BMT (107); complications after BMT (infections, GvHD) (63); chemotherapy on protocols of SAKK (105); other chemotherapies (64); antilymphocyte globulin or growth factor treatment (27); splenectomies (18); neutropenic fever (62); patient work-up (59); terminal care (20). Patients in reverse isolation were hospitalized for a median 17 (1-142) days; in the LAF unit for 52 (1-121) days. The cumulative duration of hospitalization for chemotherapy for acute leukemia (3 cycles of induction and consolidation treatment) is 79 (18-149) days; for chemotherapy + BMT in first remission 129 (85-223) days. The length of hospitalization and the data concerning mortality show what kind of difficulties the team has to face. At the end of the observation period 153 of the 287 patients were alive after a median observation period of about 2 years; 65 died in the isolation ward. This overview of the first 4 years of the isolation ward gives information about the number of patients and duration of hospitalization and provides for better planning and an estimate of funding needs in the hospital.

UNLABELLED:Since October 1988 there has been an isolation ward at Basle Cantonal Hospital. Its purpose is to treat patients with high dose chemotherapy and bone marrow transplantation under protective isolation and by standardized criteria. The isolation ward has two sub-units, viz. the reverse isolation for neutropenic patients (8 single room units) and the LAF unit (5 laminar airflow units) for allogeneic bone marrow transplantation (BMT). Up to July 1992, 287 patients (152 males and 133 females) required 527 hospitalizations. The median age was 41 (5-82) years in the reverse isolation unit and 28 (4-61) years in the LAF unit. Bed occupation was 90% and 82% throughout the period. 71% of patients were from the Basle area and the rest from elsewhere in Switzerland or from other countries.DIAGNOSIS:acute leukemias (112); myelodysplastic or myeloproliferative syndromes (52); severe aplastic anemia or agranulocytosis (46); lymphoproliferative syndromes (50); solid tumors (28). Indications for hospitalisation: BMT (107); complications after BMT (infections, GvHD) (63); chemotherapy on protocols of SAKK (105); other chemotherapies (64); antilymphocyte globulin or growth factor treatment (27); splenectomies (18); neutropenic fever (62); patient work-up (59); terminal care (20). Patients in reverse isolation were hospitalized for a median 17 (1-142) days; in the LAF unit for 52 (1-121) days.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone marrow transplants were carried out in 18 patients with chronic myelogenous leukemia (CML) in the chronic phase (CP). 12 (67%) are still alive, 11 without evidence of leukemia after a mean observation period of 24 (3-44) months, 1 relapsed and 6 died. The most frequent cause of death was GvHD and interstitial pneumonia (5). 1 patient died of septicemia. 2 grafts were performed in patients with CML in the accelerated phase (AP); both died, one from leukemic relapse and one from GvHD. The authors also participated in an international study in which 117 patients were evaluated. In CP there was a survival plateau at 63%, in AP at 36% and in blastic crisis at 12%. In CP mortality was primarily age-dependent and relapses occurred in only 7%. It is concluded that bone marrow transplantation (BMT) is a highly successful treatment for CML, with the CP the optimum moment for grafting. Longlasting cytogenetic and clinical remissions with potential for cure are possible in a high percentage of patients. The incidence of transplant-related mortality is acceptable. The incidence of leukemic relapse is low in CP. Patients under age 40 with HLA-identical siblings should be transplanted in CP. At present BMT is the only treatment with curative potential for CML.