Engraftment and survival after unrelated-donor bone marrow transplantation: A report from the national marrow donor program

Stella M. Davies, Craig Kollman, Claudio Anasetti, Joseph H. Antin, James Gajewski, James T. Casper, Auayporn Nademanee, Harriet Moreen, Roberta King, Dennis Confer, Nancy A. Keman

    Research output: Contribution to journalArticle

    171 Scopus citations

    Abstract

    We analyzed engraftment of unrelated-donor (URD) bone marrow in 5246 patients who received transplants facilitated by the National Marrow Donor Program between August 1991 and June 1999. Among patients surviving at least 28 days, 4% had primary graft failure (failure to achieve an absolute neutrophil count > 5 x 108/L before death or second stem-cell infusion). Multivariate logistic regression analysis showed that engraftment was associated with marrow matched at HLA-A, HLA-B, and DRB1; higher cell dose; younger recipient; male recipient; and recipient from a non -African American ethnic group. More rapid myeloid engraftment was associated with marrow serologically matched at H L A-A and HLA-B, DRB1 match, higher cell dose (in non-T-cell-depleted cases), younger recipient, recipient seronegativity for cytomegalovirus (CMV), male donor, no methotrexate for graft-versus-host disease prophylaxis, and transplantation done in more recent years. A platelet count higher than 50 x 109/L was achieved by 47% of patients by day 100. Conditional on survival to day 100, survival at 3 years was 61% in those with platelet engraftment at day 30, 58% in those with engraftment between day 30 and day 100, and 33% in those without engraftment at day 100 (P < .0001). Factors favoring platelet engraftment were higher cell dose, DRB1 allele match, recipient seronegativity for CMV, HLA-A and H L A-B serologically matched donor, and male donor. Secondary graft failure occurred in 10% of patients achieving initial engraftment, and 18% of those patients are alive. These data demonstrate that quality of engraftment is an important predictor of survival after URD bone marrow transplantation.

    Original languageEnglish (US)
    Pages (from-to)4096-4102
    Number of pages7
    JournalBlood
    Volume96
    Issue number13
    DOIs
    StatePublished - 2000

    ASJC Scopus subject areas

    • Biochemistry
    • Immunology
    • Hematology
    • Cell Biology

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