[Analysis of 66 cases received hematopoietic stem cell transplantation from unrelated donors].
OBJECTIVE
To improve the outcome of hematopoietic stem cell transplantation from unrelated donors.


METHODS
Sixty-six patients with hematological diseases (40 cases of acute leukemia, 24 chronic myeloid leukemia, and one each severe aplastic anemia and beta-thalassemia) received bone marrow (BMT, n = 48) or peripheral blood stem cell transplantation (PBSCT, n = 18) from HLA-compatible unrelated donors after BUCY or TBI conditioning. Forty patients received longer and intensive GVHD prophylaxis (cyclosporin A from day -10 combined with mycophenolate mofetil).


RESULTS
Sixty-four patients achieved sustained donor engraftment. The median time of leukocyte engraftment was 15 days, being significantly earlier in PBSCT group compared with BMT group (12 vs 16 days, P = 0.002). The cumulative incidence rates of grades I-II and III-IV acute GVHD at day 100 were 57.15% and 32.25%, respectively. Chronic GVHD was seen in 21 of the 36 evaluable cases and ten of them were extensive type. Six patients relapsed and 27 dead, the overall survival at 5 years was 52.91%. The COX method analysis showed that HLA-compatible level and source of graft affected the incidence of aGVHD. The patients transplanted from HLA-matched donor with high resolution and PBSCT had the less probability for aGVHD. Patients without GVHD or with longer and intensive GVHD prophylaxis had significantly improved OS.


CONCLUSIONS
The key to improvement the outcome of HCT from unrelated donor is to reduce the incidence and severity of aGVHD by selecting the HLA-matched donor, intensifying the immunosuppression at the early stage of transplantation.
Chen
Yu-hong
YH
Institute of Hematology, People's Hospital, Peking University, Beijing 100044, China.
Huang
Xiao-jun
XJ
Chen
Huan
H
Xu
Lan-ping
LP
Liu
Dai-hong
DH
Jiang
Qian
Q
Zhang
Yao-chen
YC
Han
Wei
W
Gao
Zhi-yong
ZY
Wang
Jing-zhi
JZ
Liu
Kai-yan
KY
Wu
Tong
T
Lu
Dao-pei
DP
D000293:Adolescent; D000328:Adult; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome