Bone marrow transplantation using unrelated donors for patients with advanced leukemia or bone marrow failure

James L. Gajewski, Winston G. Ho, Stephen A. Feig, Lynne Hunt, Nancy Kaufman, Richard E. Champlin

    Research output: Contribution to journalArticle

    52 Scopus citations

    Abstract

    Thirty-four patients received bone marrow transplants from unrelated donors. Donors and recipients were phenotypically matched for 6 of 6 HLA-A, B, and DR antigens in 27 cases and at 5 of 6 antigens in 7 cases. Twenty-three patients had leukemia, six had myelodysplasia, and five had aplastic anemia. Twenty-four patients had durable engraftment. Five died of sepsis prior to engraftment. Five patients failed to engraft; 2 of these patients had autologous bone marrow recovery. Seventeen patients developed grade >II acute graft-versus-host disease for an actuarial probability of 67±20%. The severity of acute graft-versus-host disease and its mortality appeared increased for recipients matched for 5 of 6 HLA-A, B, and DR antigens. Of the 34 patients, 13 (38%) are alive; actuarial survival beyond 6 months is 44±17%. None of the 25 leukemia and myelodysplasia patients achieving engraftment have relapsed. For leukemia and myelodysplasia recipients of 6 of 6 HLA-matched grafts, actuarial survival at 6 months was 55±21% compared with 14±26% for recipients matched for 5 of 6 HLA loci (P=0.19). Infection and acute graft-versus-host disease were the primary causes of death in the engrafted patients. Survival for aplastic anemia patients was 20%. Late deaths due to pneumonia and bronchiolitis obliterans occurred after one year in 2 patients. Closely matched unrelated donor bone marrow transplants are associated with a higher incidence of graft failure and graft-versus-host disease than typically reported for transplants from HLA-identical siblings, but these preliminary data suggest a lower rate of relapse.

    Original languageEnglish (US)
    Pages (from-to)244-249
    Number of pages6
    JournalTransplantation
    Volume50
    Issue number2
    DOIs
    StatePublished - Aug 1990

    ASJC Scopus subject areas

    • Transplantation

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