title: Prospective evaluation of unrelated donor bone marrow transplantation. The International Marrow Unrelated Search and Transplant (IMUST) Study.
abstract: The International Marrow Unrelated Search and Transplant (IMUST) Study has prospectively assessed outcome of unrelated donor BMT (UD-BMT) in comparison with a matched cohort of patients treated by HLA-identical sibling BMT (ID-BMT). We report an interim analysis of the first 165 UD-BMT and 368 ID-BMT. Eighty-two percent of UD-BMT pairs were matched by serology for HLA-A, B and DR, 10% were less well matched and HLA matching data was incomplete in 8%. The Kaplan-Meier estimated probability of survival until day 400 was 0.42 (95% confidence limits 0.33-0.51) after UD-BMT and 0.62 (0.56-0.68) after ID-BMT (p = < 0.001). Probability of engraftment by day 100 was 0.90 (0.85-0.95) and 0.95-0.99) after UD-BMT and ID-BMT, respectively (p = < 0.001). Cumulative probability of acute GVHD by day 100 was 0.52 (0.45-0.60) and 0.42 (0.37-0.47) after UD-BMT and ID-BMT, respectively (p = 0.009). After UD-BMT, 52% of patients with early disease survived until day 400 (40-64%) and 27% (14-40%) with advanced disease (p = < 0.001). Multifactorial analysis of survival showed success was related to the centre's experience of UD-BMT and this effect was modified by conditioning protocol. Increased probability of survival after UD-BMT in centres with most experience of the procedure is novel finding. We conclude UD-BMT is a more difficult procedure than ID-BMT but results are acceptable in patients with early disease and when UD-BMT is carried out in experienced centres.
authors.affiliation: Department of Transplantation Sciences, Bristol University, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hows
authors.forename: B A
authors.initials: BA
authors.lastname: Bradley
authors.forename: S
authors.initials: S
authors.lastname: Gore
authors.forename: T
authors.initials: T
authors.lastname: Downie
authors.forename: M
authors.initials: M
authors.lastname: Howard
authors.forename: E
authors.initials: E
authors.lastname: Gluckman
mesh_terms: D000208:Acute Disease; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000401:mortality; D015331:Cohort Studies; D006086:Graft vs Host Disease / Q000209:etiology; D006801:Humans; D015993:Life Tables; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome