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Histocompatible unrelated volunteer donors compared with HLA nonidentical
family donors in marrow transplantation for aplastic anemia and leukemia
JM Hows, JL Yin, J Marsh, D Swirsky, L Jones, JF Apperley, DC James, S Smithers, JR Batchelor and JM Goldman
We treated 14 patients by transplantation of marrow from unrelated
volunteer donors. Eight patients had severe aplastic anemia, 3 had chronic
granulocytic leukemia, and 3 had Fanconi's anemia. The results are compared
with those of a group of 14 similar patients transplanted concurrently from
human leukocyte antigen (HLA)-mismatched family members: Sustained
engraftment was achieved in 8 of 14 patients in both groups; one additional
patient survived with autologous marrow reconstitution following an
unrelated donor transplant. In the unrelated donor group, 6 of 9 evaluable
patients developed grade III through IV acute graft-v-host disease, as
compared with 4 of 9 patients after family-mismatched transplants. Overall
survival was similar in the two groups. In the unrelated donor group 4 of
14 (29%) patients survived (median survival 1,299 days) as compared with 5
of 14 (36%) in the mismatched-family donor group (median survival 808
days). In both groups, patients with HLA phenotypically matched donors
fared better than those with donors who were mismatched for one or more HLA
antigen. Of the patients transplanted from HLA phenotypically matched
donors 6 of 12 patients (50%) survived, as compared with 3 of 16 patients
(19%) transplanted from HLA-mismatched donors. We conclude that unrelated
donor bone marrow transplantation (BMT) should be considered in those cases
of leukemia or bone marrow failure in which the chance of cure using
conventional therapy is remote and a HLA genotypically or phenotypically
matched family donor is not available.
Volume 68,
Issue 6,
pp. 1322-1328,
12/01/1986
Copyright © 1986 by The American Society of Hematology
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