title: Outcomes of transplantation with matched-sibling and unrelated-donor bone marrow in children with leukaemia.
abstract: BACKGROUND
  For most conditions amenable to bone-marrow transplantation, grafts from HLA-matched but unrelated donors have yielded poorer results than those obtained from matched-sibling donors. We assessed this pattern in the light of improvements in donor selection and post-transplant supportive care.
  
  
  METHODS
  We reviewed transplant outcome in 103 consecutive patients with childhood leukaemia who underwent allogeneic bone-marrow transplantation with HLA-matched sibling marrow (n = 52) or matched unrelated donor marrow (n = 51) between May, 1990, and March, 1996, at St Jude Children's Research Hospital.
  
  
  RESULTS
  Analysis of engraftment, frequency of procedure-related complications, and disease-free survival revealed no advantage from use of matched-sibling marrow. The 2-year disease-free survival estimate for standard-risk recipients of matched-sibling marrow was 81 [8.1]% compared with 73 [12.1]% in the unrelated donor marrow group (p = 0.77). In the high-risk category, patients with a matched-sibling donor had a 2-year disease-free survival of 31 [11.6]%, compared with 32 [15.1]% among recipients of matched unrelated donor marrow (p = 0.87).
  
  
  CONCLUSIONS
  We believe this improved result with unrelated donor marrow is a consequence of recent innovations in histocompatibility matching, prevention of graft-versus-host disease (GvHD), and antiviral prophylaxis. We suggest that such grafts can now be used in patients at both standard and high risk without compromising treatment outcome.
authors.affiliation: Division of Bone Marrow Transplantation, Children's Research Hospital, Memphis, TN, USA.
authors.forename: S
authors.initials: S
authors.lastname: Hongeng
authors.forename: R A
authors.initials: RA
authors.lastname: Krance
authors.forename: L C
authors.initials: LC
authors.lastname: Bowman
authors.forename: D K
authors.initials: DK
authors.lastname: Srivastava
authors.forename: J M
authors.initials: JM
authors.lastname: Cunningham
authors.forename: E M
authors.initials: EM
authors.lastname: Horwitz
authors.forename: M K
authors.initials: MK
authors.lastname: Brenner
authors.forename: H E
authors.initials: HE
authors.lastname: Heslop
mesh_terms: D016026:Bone Marrow Transplantation; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000517:prevention & control; D006650:Histocompatibility Testing; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality / Q000628:therapy*; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy*; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D014777:Virus Diseases / Q000453:epidemiology