title: Outcome of patients activating an unrelated donor search: the impact of transplant with reduced intensity conditioning in a large cohort of consecutive high-risk patients.
abstract: An unrelated donor (UD) search was submitted to the Italian Bone Marrow Donor Registry between February 2002 and December 2004, for 326 consecutive patients with hematological malignancies, eligible for a reduced intensity conditioning (RIC) UD transplant. Only two regimens were allowed: melphalan, alemtuzumab, fludarabine and total body irradiation of 200 cGy (regimen A) and thiotepa, cyclophosphamide, anti-thymocyte globulin (regimen B). The outcome of patients receiving an UD transplant (n=121) was compared with patients who did not find a donor (n=205), in a time dependent analysis, correcting for time to transplant. The median follow up from activation of donor search was 6.1 years. UD transplant was associated with a significantly better survival in patients with acute leukemia and non-Hodgkin's lymphoma (NHL) whereas only a favorable trend was documented for Hodgkin's disease. No survival benefit was registered for chronic leukemias. The outcome of the two different conditioning regimens was comparable, in terms of survival, transplant-related mortality and graft versus host disease. In conclusion, finding an UD and undergoing a RIC transplant significantly improves survival of patients with acute leukemia and NHL. The advantage is less clear for HD and chronic leukemias. The role of different conditioning regimens remains to be elucidated by prospective clinical trials.
authors.affiliation: The Hematology and Bone Marrow Transplant Units of Ospedali Riuniti di Bergamo, Bergamo, Italy. arambaldi@ospedaliriuniti.bergamo.it
authors.forename: A
authors.initials: A
authors.lastname: Rambaldi
authors.forename: A
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: R
authors.initials: R
authors.lastname: Fanin
authors.forename: F
authors.initials: F
authors.lastname: Ciceri
authors.forename: F
authors.initials: F
authors.lastname: Bonifazi
authors.forename: M
authors.initials: M
authors.lastname: Falda
authors.forename: G
authors.initials: G
authors.lastname: Lambertenghi-Deliliers
authors.forename: F
authors.initials: F
authors.lastname: Benedetti
authors.forename: B
authors.initials: B
authors.lastname: Bruno
authors.forename: P
authors.initials: P
authors.lastname: Corradini
authors.forename: P E
authors.initials: PE
authors.lastname: Alessandrino
authors.forename: P
authors.initials: P
authors.lastname: Iacopino
authors.forename: W
authors.initials: W
authors.lastname: Arcese
authors.forename: R
authors.initials: R
authors.lastname: Scimè
authors.forename: R
authors.initials: R
authors.lastname: Raimondi
authors.forename: S
authors.initials: S
authors.lastname: Sica
authors.forename: L
authors.initials: L
authors.lastname: Castagna
authors.forename: T
authors.initials: T
authors.lastname: Lamparelli
authors.forename: R
authors.initials: R
authors.lastname: Oneto
authors.forename: L
authors.initials: L
authors.lastname: Lombardini
authors.forename: S
authors.initials: S
authors.lastname: Pollichieni
authors.forename: A
authors.initials: A
authors.lastname: Algarotti
authors.forename: A
authors.initials: A
authors.lastname: Carobbio
authors.forename: N
authors.initials: N
authors.lastname: Sacchi
authors.forename: A
authors.initials: A
authors.lastname: Bosi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D061349:Unrelated Donors; D055815:Young Adult