Marrow Transplantation From Unrelated Volunteer Donors

Abstract

Marrow transplants from human leukocyte antigen (HLA)-compatible unrelated volunteer donors have become feasible for more than 30% of patients without a family match and have allowed long-term, disease-free survival in 15-65% of patients with a variety of hematological disorders. However, unrelated donor transplants have a higher incidence of graft failure and graft versus host disease (GVHD) than do HLA-matched sibling transplants. This increase may be due to disparities between donor and recipient for undetected HLA determinants or for non-HLA histocompatibility genes. Because of the large number of HLA loci and their high degree of polymorphism, fully compatible donors will not be found for most patients. Fortunately, a limited degree of HLA mismatch does not necessarily impair long-term survival in patients with hematologic malignancy. Current studies are defining the risk associated with mismatching for each histocompatibility locus and are developing methods for marrow transplantation that can decrease morbidity and improve survival despite genetic disparity between donor and recipient. Annu. Rev. Med. 1995.46:169-179. Downloaded from www.annualreviews.org Access provided by University of California -San Francisco UCSF on 02/04/15. For personal use only.Quick links to online content Further ANNUAL REVIEWS

Bone marrow MR imaging as predictors of outcome in hemopoietic stem cell transplantation

“…Another limitation of our study is the study group's heterogeneity with regard to age, transfusion and chelation schema. This could be a reflection of the difficulty in finding HLA-compatible subjects for HSCT [25]. However, absolute homogeneity in such a group of patients is impossible, since the severity of the disease is variable and the treatment individualized.…”

Listing of Common HLA Alleles and Haplotypes Based on the Study of 356 Families Residing in the Paris, France, Area: Implications for Unrelated Hematopoietic Stem Cell Donor Selection

“…among HLA-A, -B serotyped and HLA-DR serotyped or DNA broadly typed registry donors [12][13][14]. Final typing of donors, at the required genomic level, reveals that more than 70% who are serologically identical to the recipient with respect to HLA-A, -B, and -DR antigens in the registries are in fact mismatched at one or more HLA-A, -B, -C, -DRB1, or -DQB1 loci [15][16][17][18][19][20][21][22].…”

Bone marrow transplantation from partially HLA‐matched related donors in adults with leukaemia: The Experience at the University Hospital of Essen, Germany

“…Nevertheless, we have decided to prefer related donors exhibiting only one HLA-mismatch in GVH-and/or HVG direction to a fully HLA-matched unrelated donor for the following reasons: (i) our study has demonstrated overall survival (and the incidence of GVHD after family HLA non-identical BMT and after family HLA-identical BMT) to be almost identical, thus extrapolating the original Seattle experience to our 'smaller-sized' centre, and (ii) several authors (for review, see Anasetti et al, 1995) found overall survival to be significantly lower and the risk of GVHD to be significantly higher after BMT from fully matched unrelated donors compared to family HLA-identical BMT (McGlave et al, 1993;Kernan et al, 1993;Anasetti et al, 1994;Hows et al, 1993). At present there is no definite answer to the first question, because larger prospective studies directly aimed at this issue have not yet been undertaken.…”