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Transplantation of marrow cells from unrelated donors for treatment of
high-risk acute leukemia: the effect of leukemic burden, donor HLA-
matching, and marrow cell dose
J Sierra, B Storer, JA Hansen, JW Bjerke, PJ Martin, EW Petersdorf, FR Appelbaum, E Bryant, TR Chauncey, G Sale, JE Sanders, R Storb, KM Sullivan and C Anasetti
Fred Hutchinson Cancer Research Center, Veterans Affairs Medical Center,
University of Washington, Seattle, USA.
Transplantation of hematopoietic stem cells from an HLA-compatible
unrelated volunteer is an option for patients with acute leukemia lacking a
family match. However, criteria for patient and donor selection and the
most effective transplant procedures, including the number of hematopoietic
cells, remain to be defined. We tested factors influencing outcome of 174
patients with primary acute leukemia receiving non-T-cell depleted marrow
from unrelated donors. Median patient age was 20 years (range, 0.5 to 54
years). A multivariable analysis found that leukemia in remission at the
time of transplantation was associated with improved leukemia-free survival
(relative risk [RR] of treatment failure: 0.5, confidence interval [CI]:
0.3 to 0.7), and presence of blasts in the peripheral blood, as opposed to
marrow involvement only or isolated extramedullary relapse, was associated
with impaired outcome (RR of treatment failure: 2.5, CI: 1.7 to 5.0). The
use of donors with a limited HLA-mismatch was associated with decreased
leukemic relapse (RR: 0.5, CI: 0.3 to 0.9) but no improvement in
leukemia-free survival compared with HLA-matched unrelated donors.
Transplantation of a marrow cell dose above the median value of 3.65 x
10(8)/kg was associated with faster neutrophil (RR: 1.5, CI: 1.1 to 2.0)
and platelet (RR: 4.5, CI: 2.7 to 7.5) engraftment, and decreased incidence
of severe acute graft-versus-host disease (RR: 0.6, CI: 0.4 to 0.9). In
patients transplanted in remission, the use of a marrow cell dose above the
median translated into less nonleukemic death (RR: 0.2, CI: 0.1 to 0.4) and
better leukemia-free survival (RR of treatment failure: 0.3, CI: 0.2 to
0.6). Transplant in remission with a high dose of marrow cells was
associated with the best outcome in both children and adults.
Volume 89,
Issue 11,
pp. 4226-4235,
06/01/1997
Copyright © 1997 by The American Society of Hematology
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