Bone marrow transplantation from partially HLA-mismatched family donors for acute leukemia: Single-center experience of 201 patients

J. Mehta*, S. Singhal, A. P. Gee, K. Y. Chiang, K. Godder, F. van Rhee, S. DeRienzo, W. O'Neal, L. Lamb, P. J. Henslee-Downey

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

74 Scopus citations

Abstract

Between February 1993 and December 1999, 201 patients (1-59 years old, median 23) with acute leukemia (67% not in remission) underwent ex vivo T-cell-depleted (TCD) bone marrow transplants (BMT) from partially mismatched related donors (PMRD; 92% mismatched for 2-3 HLA A, B, DR antigens). Conditioning comprised total body irradiation, cyclophosphamide, cytarabine, etoposide, anti-thymocyte globulin (ATG), and methyl-prednisolone. Graft-versus-host disease (GVHD) prophylaxis comprised partial TCD with OKT3 (n=143) or T10B9 (n=58), steroids, ATG, and cyclosporine. The engraftment rate was 98%. The cumulative incidences of grades II-IV acute GVHD and chronic GVHD were 13 and 15%, respectively. The 5-year cumulative incidences of relapse and transplant-related mortality (TRM) were 31 and 51%, respectively. The actuarial 5-year overall survival (OS) and disease-free survival (DFS) probabilities were 19 and 18%, respectively. Patient age >15 years, active disease at transplant, donor age >25 years, and 3-antigen donor mismatch (host-versus-graft) affected the outcome adversely. The actuarial 5-year OS of four groups of patients identified based upon these risk factors was 39, 20, 13, and 0%, respectively (P<0.0001). We conclude that PMRD BMT is a potential treatment option for patients with high-risk acute leukemia who require an alternative donor transplant and fall into a group with a reasonable expected outcome.

Original languageEnglish (US)
Pages (from-to)389-396
Number of pages8
JournalBone Marrow Transplantation
Volume33
Issue number4
DOIs
StatePublished - Feb 2004

Keywords

  • Acute leukemia
  • Allogeneic transplantation
  • HLA mismatch

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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