title: Bone marrow transplantation with HLA partially matched related donors.
abstract: BACKGROUND
  Approximately one-fourth of patients who could benefit from bone marrow transplantation (BMT) are served by a genotypically identical sibling donor. When patients do not have an HLA-matched donor, alternative marrow sources should be explored. The way to allow survival in some patients is to perform two- or three loci HLA mismatched BMT. Preliminary results with BMT in partially-matched, related donors performed at Veterans General Hospital-Taipei are reported.
  
  
  METHODS
  Between 1985 and 1994, a total of 121 patients were enrolled in this study. Ten patients received BMT with HLA partially-matched, related donor, including 2 acute nonlymphocytic leukemia (ANLL), 5 chronic myelocytic leukemia (CML) and 3 severe aplastic anemia (SAA). Three and four hematologically malignant patients received cyclophosphamide (Cy) + radiotherapy (RT) and Cy + Busulfan(Bu) preconditioning regimens, respectively; three SAA patients received standard Cy + RT regimen. Additional prophylaxis against graft-versus-host disease (GVHD) consisted of methotrexate (MTX) and cyclosporin-A (CSA). The median follow up was 36 months. Seven were 2-loci disparate and 3 were 3-loci.
  
  
  RESULTS
  Engraftment developed with a mean of 20.9 days after transplant. Nonengraftment rate was 1/10 (10%), delayed graft failure 2/10(20%) and venoocculsive disease (VOD) 1/10(10%). The percentage of patients who developed grade II to IV acute GVHD was low (13.6% of those mismatched at 0 locus, 31.6% mismatched at 1 loci and 14.3% at > or = 2 loci. p = 0.181). Extensive chronic GVHD occurred in 16.7% (34.1% of those mismatched at 0 locus, 41.2% mismatched at 1 loci and 16.7% at 2 loci. p = 0.492). There were five deaths. The other 5 still survived at 36 months of follow-up. Log-rank analysis revealed no statistical significance between those mismatched at > or = 2 vs at 1 (p = 0.146) but the difference between those mismatched at > or = 2 and at 0 (p = 0.0359) was statistically significant.
  
  
  CONCLUSIONS
  When patients requiring BMT without an HLA identical sibling donor, an alternative transplant from haploidentical family members remains a viable option, especially when a patient has CML, SAA or other refractory hematologic malignancies.
authors.affiliation: Department of Medicine, Veterans General Hospital-Taipei, Taiwan, R.O.C.
authors.forename: P M
authors.initials: PM
authors.lastname: Chen
authors.forename: T J
authors.initials: TJ
authors.lastname: Chiou
authors.forename: R K
authors.initials: RK
authors.lastname: Hsieh
authors.forename: C H
authors.initials: CH
authors.lastname: Tzeng
authors.forename: W S
authors.initials: WS
authors.lastname: Wang
authors.forename: C C
authors.initials: CC
authors.lastname: Yen
authors.forename: S L
authors.initials: SL
authors.lastname: Tung
authors.forename: J H
authors.initials: JH
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000401:mortality; D002648:Child; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male