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Acute Leukemia

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

Bone Marrow Transplantation volume 33, pages 389–396 (2004)Cite this article

Summary:

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 methylprednisolone. 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.

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Acknowledgements

This paper is dedicated to the nursing, supportive, and scientific staff of the Division of Transplantation Medicine of the South Carolina Cancer Center, and our patients and their families. This work would not have been possible without their indefatigable enthusiasm and support. In particular, we acknowledge S Abhyankar, S Adams, J Benton, K Bridges, L Bryant, S Carpenter, N Christiansen, J Fitzpatrick, A Fontana, B Foster, S Geier, K Goon-Johnson, S Heiney, K Higgins-Smith, C Lee, J McGuirk, R McKnight, W Neglia, M Paoli, A Pati, P Patterson, K Westfall, G Wingo, and D Worthington-White for their efforts and dedication to clinical care, laboratory, and research management during significant portions of the work.

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Authors and Affiliations

  1. Division of Transplantation Medicine, South Carolina Cancer Center, University of South Carolina, Columbia, SC, USA

    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

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  1. J Mehta
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  2. S Singhal
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Correspondence to J Mehta.

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Mehta, J., Singhal, S., Gee, A. et al. Bone marrow transplantation from partially HLA-mismatched family donors for acute leukemia: single-center experience of 201 patients. Bone Marrow Transplant 33, 389–396 (2004). https://doi.org/10.1038/sj.bmt.1704391

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