Equivalent outcomes in patients with chronic myelogenous leukemia after early transplantation of phenotypically matched bone marrow from related or unrelated donors.
OBJECTIVE
To determine if the favorable outcomes after transplantation of matched sibling donor bone marrow in patients with chronic myelogenous leukemia can be achieved using bone marrow from an HLA-A,B/DRB1-matched unrelated donor.


METHODS
Between April 1983 and December 1997, 141 patients with chronic myelogenous leukemia in its first chronic phase received a bone marrow transplant from a matched sibling donor (n = 96) or an HLA-A,B/DRB1-matched unrelated donor (n = 45). The median age of matched sibling donor recipients was 38 years (range, 8 to 56 years) and of unrelated donor recipients was 35 years (range, 3 to 53 years; P = 0.03). The median follow-up was 6 years (range, 1 to 15 years) in matched sibling donor recipients and 5 years (range, 2 to 10 years) in unrelated donor recipients.


RESULTS
There was no significant difference in the 5-year survival rates of matched sibling donor recipients [58%; 95% confidence interval (CI), 48% to 68%] and unrelated donor recipients (53%; 95% CI, 39% to 67%; P = 0.4). Among patients who underwent transplantation within 1 year after diagnosis, the 5-year survival rate of matched sibling donor recipients (76%; 95% CI, 65% to 87%) was not significantly different (P = 0.5) from that of unrelated donor recipients (70%; 95% CI, 52% to 88%). In multiple regression analysis, longer time from diagnosis to transplantation, T-cell depletion, and grades III or IV graft versus host disease were independently associated with poorer survival. Transplantation of unrelated donor bone marrow was not associated with mortality (relative risk, 1.1; 95% CI, 0.6 to 2.1; P = 0.7).


CONCLUSIONS
Transplantation of bone marrow from a matched sibling donor or an HLA-A,B/DRB1-matched unrelated donor produces equivalent outcomes in patients with chronic myelogenous leukemia, particularly if the transplant takes place within 1 year after diagnosis.
Davies
S M
SM
Blood and Marrow Transplant Program, University of Minnesota, Minneapolis 55455, USA.
DeFor
T E
TE
McGlave
P B
PB
Miller
J S
JS
Verfaillie
C M
CM
Wagner
J E
JE
Weisdorf
D J
DJ
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology*; D015234:HLA-A Antigens / Q000276:immunology; D015235:HLA-B Antigens / Q000276:immunology; D006684:HLA-DR Antigens / Q000276:immunology; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D010641:Phenotype; D016016:Proportional Hazards Models; D012306:Risk; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors; D019172:Transplantation Conditioning; D016896:Treatment Outcome
D006680:HLA Antigens; D015234:HLA-A Antigens; D015235:HLA-B Antigens; D006684:HLA-DR Antigens