Hlamatched Unrelated Grafts

Maris et al. reported the results in 89 patients given grafts from unrelated donors matched for HLA-A, -B, and -C antigens and HLA-DRB1 and -DQBI alleles.39 The median patient age was 53 (range 5-69) years. Diagnoses included were acute leukemias (n = 17), myelodysplastic syndromes (n = 21), chronic leukemias (n = 19), multiple myeloma (n = 7), lymphomas (n = 17), or other hematologic malignancies (n = 8). Stem cell sources were marrow (n = 18) or G-PBMC (n = 71). Durable engraftment was observed in 85% of G-PBMC and 56% of marrow recipients (P = 0.007). Factors associated with increased risks of graft rejection were marrow instead of G-PBMC as stem cell source and the absence of chemotherapy preceding HCT. Cumulative probabilities of grades II, III, and IV acute GvHD were 42, 8, and 2%, respectively. Chronic extensive GvHD was seen in 37% of patients. Grades II-IV acute GvHD (P = 0.02) and chronic GvHD (P = 0.04) were associated with decreased risks of relapse. Nonrelapse mortality at day 100 and 1 year were 11 and 16%, respectively. One-year overall and progressionfree survivals were 57 and 44% for G-PBMC recipients, and 33 (P = 0.13) and 17% (P = 0.02), respectively, for marrow recipients. Risk factors favorably associated with improved overall survival in a multivariate analysis included <5% blasts in the marrow before HCT, low relapse risk disease category, transplantation from female donors, and CD3+ cell doses >2.33 X 108 cells/kg.

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