Engraftment and survival after unrelated-donor bone marrow transplantation: a report from the national marrow donor program.
We analyzed engraftment of unrelated-donor (URD) bone marrow in 5246 patients who received transplants facilitated by the National Marrow Donor Program between August 1991 and June 1999. Among patients surviving at least 28 days, 4% had primary graft failure (failure to achieve an absolute neutrophil count > 5 x 10(8)/L before death or second stem-cell infusion). Multivariate logistic regression analysis showed that engraftment was associated with marrow matched at HLA-A, HLA-B, and DRB1; higher cell dose; younger recipient; male recipient; and recipient from a non-African American ethnic group. More rapid myeloid engraftment was associated with marrow serologically matched at HLA-A and HLA-B, DRB1 match, higher cell dose (in non-T-cell-depleted cases), younger recipient, recipient seronegativity for cytomegalovirus (CMV), male donor, no methotrexate for graft-versus-host disease prophylaxis, and transplantation done in more recent years. A platelet count higher than 50 x 10(9)/L was achieved by 47% of patients by day 100. Conditional on survival to day 100, survival at 3 years was 61% in those with platelet engraftment at day 30, 58% in those with engraftment between day 30 and day 100, and 33% in those without engraftment at day 100 (P <.0001). Factors favoring platelet engraftment were higher cell dose, DRB1 allele match, recipient seronegativity for CMV, HLA-A and HLA-B serologically matched donor, and male donor. Secondary graft failure occurred in 10% of patients achieving initial engraftment, and 18% of those patients are alive. These data demonstrate that quality of engraftment is an important predictor of survival after URD bone marrow transplantation.
Davies
S M
SM
University of Minnesota, Minneapolis, MN, USA. davie008@tc.umn.edu
Kollman
C
C
Anasetti
C
C
Antin
J H
JH
Gajewski
J
J
Casper
J T
JT
Nademanee
A
A
Noreen
H
H
King
R
R
Confer
D
D
Kernan
N A
NA
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D016026:Bone Marrow Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D015897:Comorbidity; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D005006:Ethnicity; D005260:Female; D030342:Genetic Diseases, Inborn / Q000628:therapy; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D006402:Hematologic Diseases / Q000628:therapy; D006648:Histocompatibility; D006801:Humans; D007165:Immunosuppression Therapy; D007223:Infant; D007938:Leukemia / Q000628:therapy; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000628:therapy; D010976:Platelet Count; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors; D019172:Transplantation Conditioning; D014481:United States / Q000453:epidemiology