PMID- 11806980
OWN - NLM
STAT- MEDLINE
DCOM- 20020306
LR  - 20210216
IS  - 0006-4971 (Print)
IS  - 0006-4971 (Linking)
VI  - 99
IP  - 3
DP  - 2002 Feb 1
TI  - 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.
PG  - 806-14
AB  - 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 HLA 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.
FAU - Drobyski, William R
AU  - Drobyski WR
AD  - Bone Marrow Transplant Program, Froedtert Memorial Lutheran Hospital, Medical 
      College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA. 
      bill@bmt.mcw.edu
FAU - Klein, John
AU  - Klein J
FAU - Flomenberg, Neal
AU  - Flomenberg N
FAU - Pietryga, Daniel
AU  - Pietryga D
FAU - Vesole, David H
AU  - Vesole DH
FAU - Margolis, David A
AU  - Margolis DA
FAU - Keever-Taylor, Carolyn A
AU  - Keever-Taylor CA
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Blood
JT  - Blood
JID - 7603509
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Algorithms
MH  - Bone Marrow Transplantation/*immunology/mortality/standards
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Graft Survival/immunology
MH  - Graft vs Host Disease/immunology
MH  - Haplotypes/immunology
MH  - Hematologic Neoplasms/mortality/*therapy
MH  - Histocompatibility/*immunology
MH  - Histocompatibility Testing/*methods
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - Middle Aged
MH  - Recurrence
MH  - Survival Analysis
MH  - Tissue Donors
MH  - Transplantation, Homologous/immunology/mortality/standards
MH  - Treatment Outcome
EDAT- 2002/01/25 10:00
MHDA- 2002/03/07 10:01
CRDT- 2002/01/25 10:00
PHST- 2002/01/25 10:00 [pubmed]
PHST- 2002/03/07 10:01 [medline]
PHST- 2002/01/25 10:00 [entrez]
AID - S0006-4971(20)38270-7 [pii]
AID - 10.1182/blood.v99.3.806 [doi]
PST - ppublish
SO  - Blood. 2002 Feb 1;99(3):806-14. doi: 10.1182/blood.v99.3.806.