title: Bone marrow transplantation for thalassemia from alternative related donors: improved outcomes with a new approach.
abstract: Bone marrow transplantation (BMT) performance can be limited by a lack of ideal donors, and the role of alternative donor hematopoietic cell transplantation in thalassemia is not well established. Here we used a new treatment protocol (Pc 26.1) in 16 thalassemia patients to perform BMT using phenotypically HLA-identical or 1-antigen-mismatched relatives (related donors [RDs]). We compared these results with HLA-matched sibling (matched sibling donors [MSDs]) BMT in 66 patients. The entire RD group and 88% of MSD group had sustained engraftment. Rejection incidence was 0% in the RD and 12% (95% confidence interval [95% CI], 6%-21%) in MSD groups (P = .15), with respective thalassemia-free survival probabilities of 94% (95% CI, 63%-99%) and 82% (95% CI, 70%-89%) (P = .24). Transplant-related mortality was 6% (95% CI, 1%-26%) in the RD group and 8% (95% CI, 3%-16%) in the MSD group (P = .83). The intensified new protocol was not associated with increased nonhematologic toxicity. The present data show that the Pc 26.1 preparative regimen allows thalassemia patients to safely undergo BMT from RDs who are not HLA-matched siblings, with transplant outcomes similar to patients with MSD grafts.
authors: International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinico Tor Vergata, Rome, Italy.
authors: Javid
authors: J
authors: Gaziev
authors: Marco
authors: M
authors: Marziali
authors: Antonella
authors: A
authors: Isgrò
authors: Pietro
authors: P
authors: Sodani
authors: Katia
authors: K
authors: Paciaroni
authors: Cristiano
authors: C
authors: Gallucci
authors: Marco
authors: M
authors: Andreani
authors: Manuela
authors: M
authors: Testi
authors: Gioia
authors: G
authors: De Angelis
authors: Cecilia
authors: C
authors: Alfieri
authors: Luisa
authors: L
authors: Cardarelli
authors: Michela
authors: M
authors: Ribersani
authors: Daniele
authors: D
authors: Armiento
authors: Guido
authors: G
authors: Lucarelli
mesh_terms: D000293:Adolescent; D000653:Amniotic Fluid; D016026:Bone Marrow Transplantation / Q000379:methods* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005190:Family; D005260:Female; D006084:Graft Rejection / Q000401:mortality; D006086:Graft vs Host Disease / Q000401:mortality; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D015996:Survival Rate; D013789:Thalassemia / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult