Bone marrow transplantation using unrelated donors for patients with advanced leukemia or bone marrow failure.
Thirty-four patients received bone marrow transplants from unrelated donors. Donors and recipients were phenotypically matched for 6 of 6 HLA-A, B, and DR antigens in 27 cases and at 5 of 6 antigens in 7 cases. Twenty-three patients had leukemia, six had myelodysplasia, and five had aplastic anemia. Twenty-four patients had durable engraftment. Five died of sepsis prior to engraftment. Five patients failed to engraft; 2 of these patients had autologous bone marrow recovery. Seventeen patients developed grade greater than or equal to II acute graft-versus-host disease for an actuarial probability of 67 +/- 20%. The severity of acute graft-versus-host disease and its mortality appeared increased for recipients matched for 5 of 6 HLA-A, B, and DR antigens. Of the 34 patients, 13 (38%) are alive; actuarial survival beyond 6 months is 44 +/- 17%. None of the 25 leukemia and myelodysplasia patients achieving engraftment have relapsed. For leukemia and myelodysplasia recipients of 6 of 6 HLA-matched grafts, actuarial survival at 6 months was 55 +/- 21% compared with 14 +/- 26% for recipients matched for 5 of 6 HLA loci (P = 0.19). Infection and acute graft-versus-host disease were the primary causes of death in the engrafted patients. Survival for aplastic anemia patients was 20%. Late deaths due to pneumonia and bronchiolitis obliterans occurred after one year in 2 patients. Closely matched unrelated donor bone marrow transplants are associated with a higher incidence of graft failure and graft-versus-host disease than typically reported for transplants from HLA-identical siblings, but these preliminary data suggest a lower rate of relapse.
Gajewski
J L
JL
Division of Hematology/Oncology, UCLA Center for Health Sciences.
Ho
W G
WG
Feig
S A
SA
Hunt
L
L
Kaufman
N
N
Champlin
R E
RE
D000208:Acute Disease; D000741:Anemia, Aplastic / Q000628:therapy*; D016026:Bone Marrow Transplantation / Q000276:immunology*; D002908:Chronic Disease; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000276:immunology; D006648:Histocompatibility; D006801:Humans; D007938:Leukemia / Q000628:therapy*; D007959:Lymphocyte Culture Test, Mixed; D009190:Myelodysplastic Syndromes / Q000628:therapy*; D016019:Survival Analysis