title: Unrelated donor transplantation after reduced intensity conditioning as an approach for patients lacking related donors for allogeneic stem cell transplantation.
abstract: Allogeneic stem cell transplantation (SCT) after reduced intensity conditioning (RIC) provides a new curative treatment option for patients usually not eligible for allogeneic SCT. Because the majority of patients lack HLA-identical sibling donors (SD), unrelated donor (UD) transplantation is performed increasingly. In this retrospective analysis, we have reviewed our experience with reduced-intensity conditioning regimens, comparing related and unrelated donors. From November, 1997, to February, 2002, 51 patients with hematological malignancies received allogeneic SCT after various RIC regimens. A total of 31 had a related donor, and the remaining 20 had an unrelated donor (UD). Both groups were comparable with respect to age and gender. We observed a trend toward higher rate of graft failure in the unrelated donor group with 11% compared to 3% in the related donor group (p = 0.55). The rate of acute graft-versus-host disease (GVHD) II-IV was 36% in the RD group versus 44% for the UD group; severe GVHD III-IV occurred in 26% and 22%, respectively. There were more serious infections in the unrelated donor group with 25% compared to 16%. Transplant-related mortality was 13% (RD group) versus 30% (UD group). At 21 months, progression-free survival was 30% in both groups. The Kaplan Meier estimate of overall survival was 40% (RD) and 30% (UD group). In summary, we found no statistically significant difference regarding progression free and overall survival, despite a trend for more graft failure and increased transplant-related complications associated with the use of stem cells from unrelated donors.
authors.affiliation: Department of Internal Medicine V, Univeristy of Heidelberg, D-69115 Heidelberg, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Hoepfner
authors.forename: Martin
authors.initials: M
authors.lastname: Goerner
authors.forename: Axel
authors.initials: A
authors.lastname: Benner
authors.forename: Peter
authors.initials: P
authors.lastname: Henning
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Ho
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D005190:Family; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007938:Leukemia / Q000628:therapy; D019520:Living Donors / Q000706:statistics & numerical data*; D017710:Lymphocyte Transfusion; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000628:therapy; D012189:Retrospective Studies; D035781:Siblings; D033581:Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D016019:Survival Analysis; D018183:Transplantation Chimera; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous / Q000502:physiology*; D017211:Treatment Failure; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
chemical_list: D007166:Immunosuppressive Agents