Superior survival associated with transplantation of matched unrelated versus one-antigen-mismatched unrelated or highly human leukocyte antigen-disparate haploidentical family donor marrow grafts for the treatment of hematologic malignancies: establishing a treatment algorithm for recipients of alternative donor grafts

被引:68
作者
Drobyski, WR
Klein, J
Flomenberg, N
Pietryga, D
Vesole, DH
Margolis, DA
Keever-Taylor, CA
机构
[1] Med Coll Wisconsin, Dept Med, Milwaukee, WI 53226 USA
[2] Med Coll Wisconsin, Dept Pediat, Milwaukee, WI 53226 USA
[3] Med Coll Wisconsin, Div Biostat, Milwaukee, WI 53226 USA
[4] Med Coll Wisconsin, Bone Marrow Transplant Program, Milwaukee, WI 53226 USA
关键词
D O I
10.1182/blood.V99.3.806
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The purpose of this study was to compare transplantation outcomes in patients with hematologic malignancies who received marrow grafts from either phenotypically matched unrelated, one-antigen-mismatched unrelated, or highly human leukocyte antigen (HLA)-disparate family donors. Between 1993 and 2000, 139 patients underwent transplantation from unrelated donors (81 matched and 58 mismatched) and 48 patients received marrow grafts from family donors that were mismatched at 2, 3, or 4 of 8 HILA loci. All patients received a standardized conditioning regimen and a graft-versus-host disease (GVHD) prophylaxis schedule with the exception of recipients of haploidentical marrow grafts, who received antithymocyte globulin after bone marrow transplantation as additional immunosuppression. There was no statistically significant difference in the rate of engraftment, or the cumulative Incidences of acute and chronic GVHD between any of the 3 groups. The 2-year cumulative incidence of relapse was lower in matched unrelated patients (25%, P = .01) and mismatched unrelated patients (26%, P = .014) than in haploidentical patients (42%). Transplant-related mortality was significantly higher in recipients of mismatched unrelated grafts (45%, P = .01) and haploidentical grafts (42%, P = .001) compared with recipients of matched unrelated marrow grafts (23%). This resulted in a significantly higher probability of overall survival for matched unrelated patients (58%) versus either mismatched unrelated (34%, P = .01) or haploidentical (21%, P = .002) patients. There was no statistically significant difference in survival between patients who received mismatched unrelated grafts versus those who received haploidentical grafts. This study supports a donor selection algorithm whereby patients who lack a closely matched family donor be offered a phenotypically matched unrelated donor If available. There is no apparent advantage to using a mismatched unrelated versus a highly HLA-disparate family donor. (C) 2002 by The American Society of Hematology.
引用
收藏
页码:806 / 814
页数:9
相关论文
共 47 条
[1]   SUCCESSFUL ALLOGENEIC TRANSPLANTATION OF T-CELL DEPLETED BONE-MARROW FROM CLOSELY HLA-MATCHED UNRELATED DONORS [J].
ASH, RC ;
CASPER, JT ;
CHITAMBAR, CR ;
HANSEN, R ;
BUNIN, N ;
TRUITT, RL ;
LAWTON, C ;
MURRAY, K ;
HUNTER, J ;
BAXTERLOWE, LA ;
GOTTSCHALL, JL ;
OLDHAM, K ;
ANDERSON, T ;
CAMITTA, B ;
MENITOVE, J .
NEW ENGLAND JOURNAL OF MEDICINE, 1990, 322 (08) :485-494
[2]   SUCCESSFUL ENGRAFTMENT OF T-CELL-DEPLETED HAPLOIDENTICAL 3-LOCI INCOMPATIBLE TRANSPLANTS IN LEUKEMIA PATIENTS BY ADDITION OF RECOMBINANT HUMAN GRANULOCYTE-COLONY-STIMULATING FACTOR-MOBILIZED PERIPHERAL-BLOOD PROGENITOR CELLS TO BONE-MARROW INOCULUM [J].
AVERSA, F ;
TABILIO, A ;
TERENZI, A ;
VELARDI, A ;
FALZETTI, F ;
GIANNONI, C ;
IACUCCI, R ;
ZEI, T ;
MARTELLI, MP ;
GAMBELUNGHE, C ;
ROSSETTI, M ;
CAPUTO, P ;
LATINI, P ;
ARISTEI, C ;
RAYMONDI, C ;
REISNER, Y ;
MARTELLI, MF .
BLOOD, 1994, 84 (11) :3948-3955
[3]   Treatment of high-risk acute leukemia with T-cell-depleted stem cells from related donors with one fully mismatched HLA haplotype [J].
Aversa, F ;
Tabilio, A ;
Velardi, A ;
Cunningham, I ;
Terenzi, A ;
Falzetti, F ;
Ruggeri, L ;
Barbabietola, G ;
Aristei, C ;
Latini, P ;
Reisner, Y ;
Martelli, MF .
NEW ENGLAND JOURNAL OF MEDICINE, 1998, 339 (17) :1186-1193
[4]   Survival after transplantation of unrelated donor umbilical cord blood is comparable to that of human leukocyte antigen-matched unrelated donor bone marrow: results of a matched-pair analysis [J].
Barker, JN ;
Davies, SM ;
DeFor, T ;
Ramsay, NKC ;
Weisdorf, DJ ;
Wagner, JE .
BLOOD, 2001, 97 (10) :2957-2961
[5]  
BAXTERLOWE LA, 1995, TRANSPLANT P, V27, P1377
[6]  
BEATTY PG, 1993, BLOOD, V81, P249
[7]  
BEATTY PG, 1995, TRANSPLANTATION, V45, P153
[8]   Influence of recombinant human granulocyte colony-stimulating factor (filgrastim) on hematopoietic recovery and outcome following allogeneic bone marrow transplantation (BMT) from volunteer unrelated donors [J].
Berger, C ;
Bertz, H ;
Schmoor, C ;
Behringer, D ;
Potthoff, K ;
Mertelsmann, R ;
Finke, J .
BONE MARROW TRANSPLANTATION, 1999, 23 (10) :983-990
[9]   A randomized, double-blind trial of filgrastim (granulocyte colony-stimulating factor) versus placebo following allogeneic blood stem cell transplantation [J].
Bishop, MR ;
Tarantolo, SR ;
Geller, RB ;
Lynch, JC ;
Bierman, PJ ;
Pavletic, ZS ;
Vose, JM ;
Kruse, S ;
Dix, SP ;
Morris, ME ;
Armitage, JO ;
Kessinger, A .
BLOOD, 2000, 96 (01) :80-85
[10]   Nomenclature for factors of the HLA system, 1998 [J].
Bodmer, JG ;
Marsh, SGE ;
Albert, ED ;
Bodmer, WF ;
Bontrop, RE ;
Dupont, B ;
Erlich, HA ;
Hansen, JA ;
Mach, B ;
Mayr, WR ;
Parham, P ;
Petersdorf, EW ;
Sasazuki, T ;
Schreuder, GMT ;
Strominger, JL ;
Svejgaard, A ;
Terasaki, PI .
TISSUE ANTIGENS, 1999, 53 (04) :407-446