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Successful allogeneic transplantation of T-cell-depleted bone marrow from closely HLA-matched unrelated donors.
N Engl J Med. 1990 Feb 22; 322(8):485-94.NEJM

Abstract

We describe a four-year experience with bone marrow transplantation involving closely HLA-matched unrelated donors and 55 consecutive patients with hematologic disease who were seven months to 48.6 years old (median, 18 years). An intensive pretransplantation conditioning regimen and graft-versus-host disease (GVHD) prophylaxis with CD3-directed T-cell depletion and cyclosporine were employed. Durable engraftment was achieved in 50 of 53 patients who could be evaluated (94 percent; 95 percent confidence interval, 83 to 98 percent). Acute GVHD of Grade II to IV developed in 46 percent of the patients (confidence interval, 27 to 66 percent). The incidence and severity of acute GVHD were increased in recipients of HLA-mismatched marrow as compared with recipients of phenotypically matched marrow (incidence of 53 percent [confidence interval, 37 to 68 percent] vs. 17 percent [confidence interval, 5 to 45 percent]; P less than 0.05). Extensive chronic GVHD and deaths not due to relapse also tended to be more frequent when HLA-mismatched marrow was used, but not significantly so. With a median follow-up of more than 19 months (range, greater than 9 to greater than 39), the actuarial disease-free survival of transplant recipients with leukemia and a relatively good prognosis (acute leukemia in first remission and chronic myelogenous leukemia in chronic phase) was 48 percent (confidence interval, 24 to 73 percent), and that of recipients with more aggressive leukemia was 32 percent (confidence interval, 18 to 51 percent); the actuarial survival of recipients with non-neoplastic disease was 63 percent (confidence interval, 31 to 86 percent). We conclude that marrow transplantation with closely HLA-matched unrelated donors can be effective treatment for neoplastic and non-neoplastic diseases. Although transplants from phenotypically HLA-matched unrelated donors appear to be most effective, transplants with limited HLA disparity can also be successful in some patients.

Authors+Show Affiliations

Department of Medicine, Medical College of Wisconsin, Milwaukee 53226.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

2300120

Citation

Ash, R C., et al. "Successful Allogeneic Transplantation of T-cell-depleted Bone Marrow From Closely HLA-matched Unrelated Donors." The New England Journal of Medicine, vol. 322, no. 8, 1990, pp. 485-94.
Ash RC, Casper JT, Chitambar CR, et al. Successful allogeneic transplantation of T-cell-depleted bone marrow from closely HLA-matched unrelated donors. N Engl J Med. 1990;322(8):485-94.
Ash, R. C., Casper, J. T., Chitambar, C. R., Hansen, R., Bunin, N., Truitt, R. L., Lawton, C., Murray, K., Hunter, J., & Baxter-Lowe, L. A. (1990). Successful allogeneic transplantation of T-cell-depleted bone marrow from closely HLA-matched unrelated donors. The New England Journal of Medicine, 322(8), 485-94.
Ash RC, et al. Successful Allogeneic Transplantation of T-cell-depleted Bone Marrow From Closely HLA-matched Unrelated Donors. N Engl J Med. 1990 Feb 22;322(8):485-94. PubMed PMID: 2300120.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Successful allogeneic transplantation of T-cell-depleted bone marrow from closely HLA-matched unrelated donors. A1 - Ash,R C, AU - Casper,J T, AU - Chitambar,C R, AU - Hansen,R, AU - Bunin,N, AU - Truitt,R L, AU - Lawton,C, AU - Murray,K, AU - Hunter,J, AU - Baxter-Lowe,L A, PY - 1990/2/22/pubmed PY - 1990/2/22/medline PY - 1990/2/22/entrez SP - 485 EP - 94 JF - The New England journal of medicine JO - N Engl J Med VL - 322 IS - 8 N2 - We describe a four-year experience with bone marrow transplantation involving closely HLA-matched unrelated donors and 55 consecutive patients with hematologic disease who were seven months to 48.6 years old (median, 18 years). An intensive pretransplantation conditioning regimen and graft-versus-host disease (GVHD) prophylaxis with CD3-directed T-cell depletion and cyclosporine were employed. Durable engraftment was achieved in 50 of 53 patients who could be evaluated (94 percent; 95 percent confidence interval, 83 to 98 percent). Acute GVHD of Grade II to IV developed in 46 percent of the patients (confidence interval, 27 to 66 percent). The incidence and severity of acute GVHD were increased in recipients of HLA-mismatched marrow as compared with recipients of phenotypically matched marrow (incidence of 53 percent [confidence interval, 37 to 68 percent] vs. 17 percent [confidence interval, 5 to 45 percent]; P less than 0.05). Extensive chronic GVHD and deaths not due to relapse also tended to be more frequent when HLA-mismatched marrow was used, but not significantly so. With a median follow-up of more than 19 months (range, greater than 9 to greater than 39), the actuarial disease-free survival of transplant recipients with leukemia and a relatively good prognosis (acute leukemia in first remission and chronic myelogenous leukemia in chronic phase) was 48 percent (confidence interval, 24 to 73 percent), and that of recipients with more aggressive leukemia was 32 percent (confidence interval, 18 to 51 percent); the actuarial survival of recipients with non-neoplastic disease was 63 percent (confidence interval, 31 to 86 percent). We conclude that marrow transplantation with closely HLA-matched unrelated donors can be effective treatment for neoplastic and non-neoplastic diseases. Although transplants from phenotypically HLA-matched unrelated donors appear to be most effective, transplants with limited HLA disparity can also be successful in some patients. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/2300120/Successful_allogeneic_transplantation_of_T_cell_depleted_bone_marrow_from_closely_HLA_matched_unrelated_donors_ L2 - https://www.nejm.org/doi/10.1056/NEJM199002223220801?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -