Results of allogeneic bone marrow transplants for leukemia using donors other than HLA-identical siblings.

Abstract

Although transplants from alternative donors are effective in some patients with leukemia, treatment failure is higher than after HLA-identical sibling transplants. Outcome depends on leukemia state, donor-recipient relationship, and degree of HLA matching. In early leukemia, alternative donor transplants have a more than twofold increased risk of treatment failure compared with HLA-identical sibling transplants. This difference is less in advanced leukemia.

A multicenter, retrospective study of acute kidney injury in adult patients with nonmyeloablative hematopoietic SCT

“…An analysis of a much larger population of patients with leukemia showed that the relative risk of treatment failure and the overall risk of transplant-related mortality were significantly higher for patients who received a 1-or 2-Ag-mismatched transplant compared with those for patients who received an HLA-identical sibling-donor transplant. 22 In this study, the mortality rate of patients within 1 year was found to be 27.4%, which was lower than that reported earlier. 5,8 Therefore, we suggested that nonmyeloablative HSCT might be a safe therapy for younger patients and for elderly patients without baseline organ dysfunction.…”

Single-institute comparative analysis of unrelated bone marrow transplantation and cord blood transplantation for adult patients with hematologic malignancies

“…12,25 Notably, although more than half the patients in both graft groups belonged to the high-risk disease category, 2-year relapse rates of 22% after CBT and 30% after BMT were better than previously reported. 1,3,12,25,42 Outcomes of AML patients were apparently good in our study; however, the ratio of advanced and standard AML patients was not especially different compared with other malignancies, and there were no particularly good prognostic factors in the AML group. The safety of the G-CSF-combined preparative regimen for myeloid malignancies has been confirmed [17][18][19] and might contribute to reducing the risk of posttransplantation relapse.…”

“…1-3,9,10,22 They were also superior to TRM and DFS in our BMT group, which were almost the same as previously reported. [1][2][3]22,23 Significant delays in neutrophil and platelet engraftment rates occurred after CBT; however, overall hematopoietic engraftment rates were almost the same for both grafts, as reported, 13 and early death and primary engraftment failure rates were only 4% and 8%, respectively, in our CBT series. These encouraging CBT results reflected the availability of grafts containing sufficient cell numbers 6,7 ; the median cell number was 2.5 ϫ 10 7 cells/kg and only 4 of 68 patients received cord blood containing less than 2.0 ϫ 10 7 cells per kilogram.…”

“…Bone marrow from HLA-matched unrelated donors has been an alternative graft source for these patients. [1][2][3] While cord blood cells have been increasingly used as a source of hematopoietic stem cells for allogeneic transplantation, most recipients were pediatric [4][5][6][7][8] because of the relatively lower cell doses in cord blood grafts. [4][5][6][7][8] Recently, multicenter and single-center studies of unrelated cord blood transplantation (CBT) in adults after myeloablative 9,10 or nonmyeloablative 11 conditioning regimens showed cord blood could effectively restore hematopoiesis and was associated with acceptable levels of graft-versus-host disease (GVHD).…”

Outcome of alloanergized haploidentical bone marrow transplantation after ex vivo costimulatory blockade: results of 2 phase 1 studies

“…1 However, HLA-mismatched HSCT is associated with increased graft failure, graft-versus-host disease (GVHD), and a higher risk of treatment failure. 2 GVHD is mediated predominantly by alloreactive donor T cells, which expand in vivo posttransplantation. Nonselective T-cell depletion (nsTCD) of donor grafts is an efficient method for reducing alloreactivity and is very effective at preventing GVHD.…”