Determinants of survival after human leucocyte antigen-matched unrelated donor bone marrow transplantation in adults

Juliet N. Barker, Stella M. Davies, Todd E. DeFor, Linda J. Burns, Philip B. McGlave, Jeffrey S. Miller, Daniel J. Weisdorf

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Unrelated donor (URD) bone marrow transplantation (BMT) in adults can be associated with high non-relapse mortality (NRM). Therefore, factors determining survival in 136 human leucocyte antigen (HLA)-A, B, DRB1-matched adult BMT recipients were reviewed. Fifty-four per cent of patients had chronic myelogenous leukaemia (CML) and 36% had acute leukaemia or myelodysplasia. Graft-versus-host disease (GvHD) prophylaxis was either cyclosporin A (CSA)/methotrexate (64%) or T-cell depletion and CSA/corticosteroids (34%). The probability of donor engraftment by d 45 was 97% (95% CI: 94-100). Incidence of grades III-IV acute GvHD was 18% (95% CI: 12-24) at 100 d, and chronic GvHD was 42% (95% CI: 32-52) at 2 years. At 2 years, 14% (95% CI: 8-20) had relapsed. Multiple regression analysis showed that adverse risk factors for survival were non-CML diagnosis, age > 35 years, diagnosis to transplant time of > 18 months [chronic-phase CML (CML-CP) only]; and grades III-IV acute GvHD. Patients ≤ 35 years with early CML-CP had a 2 year survival of 77% (95% CI: 54-100), which compared with a survival in advanced CML patients ≤ 35 years of 67% (95% CI: 37-97) and 37% (95% CI: 20-54) in non-CML patients. Two year survival for patients > 35 years with early CML-CP was 55% (95% CI: 33-77), 40% (95% CI: 19-61) in advanced CML and 14% (95% CI:1-27) in non-CML. Future efforts should focus on improving the outcome for older BMT recipients, especially those with diagnoses other than CML.

Original languageEnglish (US)
Pages (from-to)101-107
Number of pages7
JournalBritish journal of haematology
Volume118
Issue number1
DOIs
StatePublished - 2002

Keywords

  • Bone marrow transplantation
  • Graft-versus-host disease
  • Leukaemia
  • Unrelated donor

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