Genomic tissue typing and optimal antithymocyte globuline dose using unrelated donors results in similar survival and relapse as HLA-identical siblings in haematopoietic stem-cell transplantation for leukaemia.
Sixty-one leukaemia patients treated with haematopoietic stem cell transplantation (HSCT) from a genomic human leucocyte antigen (HLA)-A, -B and -DRbeta1 matched unrelated donor (MUD) were compared with 121 patients with an HLA-identical sibling donor. All patients received conventional conditioning. We selected all patients with unrelated donors who received optimal antithymocyte globuline (ATG) dose, 6 mg/kg. One hundred and seven patients received stem cells from peripheral blood and 75 patients received bone marrow (BM) cells. The incidences of acute graft-versus-host disease (GVHD) grades II-IV were 33.4% and 34.7% in the MUD and sibling group, respectively. After year 2001, the incidence of chronic GVHD was similar in the two groups (27.8% vs. 25.8%). There was no difference in overall survival (60% vs. 60%), transplant-related mortality (18.6% vs. 16.6%) and relapse (23% vs. 26.4%) between the two groups.


CONCLUSIONS
Haematopoietic stem cell transplantation with unrelated donors results in similar GVHD, relapse and survival as compared to using sibling donors. Reasons for this may be improved tissue-typing techniques and supportive care and optimisation of the ATG dose.
Remberger
Mats
M
Centre for Allogeneic Stem Cell Transplantation and Clinical Immunology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. mats.remberger@ki.se
Mattsson
Jonas
J
Hausenberger
Dan
D
Schaffer
Marie
M
Svahn
Britt-Marie
BM
Ringdén
Olle
O
D000293:Adolescent; D000328:Adult; D000961:Antilymphocyte Serum; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000821:virology; D005260:Female; D015894:Genome, Human / Q000235:genetics*; D006086:Graft vs Host Disease / Q000235:genetics / Q000276:immunology; D006680:HLA Antigens / Q000235:genetics* / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000235:genetics* / Q000276:immunology* / Q000601:surgery; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D035781:Siblings; D015996:Survival Rate
D000961:Antilymphocyte Serum; D006680:HLA Antigens