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Blood, 15 December 2000, Vol. 96, No. 13, pp. 4096-4102
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
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 Noreen,
Roberta King,
Dennis Confer, and
Nancy A. Kernan
From the University of Minnesota, Minneapolis, MN;
Memorial-Sloan Kettering Cancer Center, New York, NY; National Marrow
Donor Program, Minneapolis, MN; Fred Hutchinson Cancer Research Center,
Seattle, WA; Brigham and Women's Hospital and Dana-Farber Cancer
Institute, Boston, MA; MD Anderson Cancer Center, Houston, TX; Midwest
Children's Cancer Center, Milwaukee, WI; and City of Hope National
Medical Center, Duarte, CA.
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 × 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 HLA-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 × 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 HLA-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.
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