Bone marrow transplantation from related donors other than HLA-identical siblings: effect of T cell depletion.
Results of 470 bone marrow transplants from related donors other than genotypically HLA-identical siblings (alternative related donors) were analysed to identify factors associated with transplant outcome and to determine whether T cell depletion improved results. As compared to 3648 transplant from HLA-identical siblings, alternative related donor transplants were associated with increased graft failure, increased acute graft-versus-host disease (GVHD), and lower disease-free survival. The likelihood of adverse outcome correlated with increasing donor-recipient HLA-disparity. In multivariate analysis of alternative related donor transplants, donor age greater than or equal to 30 years, (relative risk [RR] 1.7, p less than 0.006), intermediate and advanced leukemia (RR 1.5 and 1.6, p less than 0.01 and p less than 0.003), infection pretransplant (RR 1.7, p less than 0.005) and 2- and 3-locus donor-recipient HLA-disparity (RR 1.3, p less than 0.04) were associated with increased risks of treatment failure. The 2-year probability of leukemia-free survival after alternative related donor transplants (n = 43) with none of these adverse prognostic features was 44% (95% confidence interval 28-59%) compared to 56% (95% confidence interval 52-59%) for similar patients receiving HLA-identical sibling transplants (n = 868, univariate p less than 0.03). T cell depletion increased graft failure and decreased acute GVHD after alternative related donor transplants but did not improve leukemia-free survival.
Ash
R C
RC
International Bone Marrow Transplant Registry, Medical College of Wisconsin, Milwaukee 53226.
Horowitz
M M
MM
Gale
R P
RP
van Bekkum
D W
DW
Casper
J T
JT
Gordon-Smith
E C
EC
Henslee
P J
PJ
Kolb
H J
HJ
Lowenberg
B
B
Masaoka
T
T
D016026:Bone Marrow Transplantation / Q000276:immunology* / Q000473:pathology; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000453:epidemiology; D006680:HLA Antigens / Q000276:immunology*; D006648:Histocompatibility / Q000276:immunology*; D006801:Humans; D015994:Incidence; D008212:Lymphocyte Depletion; D012801:Sibling Relations; D013601:T-Lymphocytes / Q000276:immunology* / Q000473:pathology; D014019:Tissue Donors
D006680:HLA Antigens