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Comparison of long-term outcomes after allogeneic hematopoietic stem cell transplantation from matched sibling and unrelated donors

Bone Marrow Transplantation volume 38, pages 799–805 (2006)Cite this article

Abstract

Long-term survivors of hematopoietic stem cell transplants remain at risk of potentially fatal complications that detract from life quality. Long-term morbidity and mortality were compared between matched recipient cohorts surviving 2 or more years and defined by donor type, HLA matched sibling donor (MSD) or volunteer unrelated donor (URD). Patients were previously entered into the prospective multicenter International Unrelated Search and Transplant Study. Thirty-nine centers provided data on 108 URD and 355 MSD recipients surviving more than 2 years. Long-term survival, performance status, chronic GvHD (c-GvHD), secondary malignancy, endocrine dysfunction, cataracts, bone necrosis and dental pathology were compared between cohorts. Twelve year survival was 77±5% for the MSD and 67±11% for the URD cohort (P=0.1). Late death occurred in 105 of 463 recipients alive at 2 years, 73 after 355 (21%) MSD and 32 after 108 (30%) URD transplants, P=0.10. Of 105 deaths, the cause was relapse in 60 and unrelated to relapse in 45 cases. Cumulative incidence of extensive c-GvHD (P=0.002), cataracts (P=0.02) and bone necrosis (P=0.02) was higher after URD transplants. No long-term difference in endocrine dysfunction, secondary malignancy and major dental pathology was detected. This landmark study will assist physicians counseling patients pre-transplant and with their long-term care post transplant.

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Acknowledgements

We thank the study patients and their referring physicians. We also acknowledge Professor Sheila Bird for her critical role in design of the original IMUST Study and for statistical analysis and interpretation of published IMUST Study data. Dr Martin Howard and Dr Tim Downie were responsible for coordinating the original IMUST Study and the Leukaemia Research Fund is acknowledged for their support of the Study from 1988–1994.

Author information

Authors and Affiliations

  1. Department of Biomedical Sciences, Faculty of Applied Sciences, University of the West of England, Bristol, UK

    J M Hows

  2. Service d' Hematologie, Hopitaux Universitaires, Geneve, Switzerland

    J R Passweg & A Tichelli

  3. Department of Hematology, University Hospital, Basel, Switzerland

    A Locasciulli

  4. Department of Hematology and BMT, Ospedale S Camillo-Forlanini, Rome, Italy

    A Locasciulli

  5. Department of Haematology, Imperial College, Hammersmith Hospital, London, UK

    R Szydlo

  6. Department of Hematology, Ospedale San Martino, Genova, Italy

    A Bacigalupo

  7. Department of Hematology, BMT Unit, Rigshospitalet, Copenhagen, Denmark

    N Jacobson

  8. Hematology Center, Karolinska University, Huddinge, Sweden

    P Ljungman

  9. Department of Paediatric Oncology/BMT, Bristol Royal Hospital for Children, Bristol, UK

    J Cornish

  10. Ann Nunn: Avon Haematology Unit, Bristol Haematology and Oncology Centre, Bristol, UK

    A Nunn

  11. Department of Orthopaedics, Southmead Hospital, Bristol, UK

    B Bradley

  12. Department of Hematology, Hopital St Louis, Paris, France

    G Socié

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  1. J M Hows
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  2. J R Passweg
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  3. A Tichelli
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  4. A Locasciulli
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  11. B Bradley
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  12. G Socié
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Consortia

for the IMUST Study Participating Centers and the Late Effects Working Party of the European Group for Blood and Marrow Transplantation (EBMT)

Corresponding author

Correspondence to J M Hows.

Appendix

Appendix

The following centers participated in the Study of the Late Effects Working Party of the European Group for Blood and Marrow Transplantation:

Royal Brisbane Hospital, Brisbane, Australia (EBMT no. 166); University Hospitals, Basel, Switzerland (EBMT no. 202); Leiden University Hospital, Leiden, The Netherlands (EBMT no. 203); University Hospital, Ulm, Germany (EBMT no. 204); Imperial College, Hammersmith Hospital, London, UK (EBMT no. 205); Rigshospitalet, Copenhagen, Denmark (EBMT no. 206); University Hospital, Zurich, Switzerland (EBMT no. 208); University Hospital Gasthuisberg, Leuven, Belgium (EBMT no. 209); Huddinge University Hospital, Huddinge, Sweden (EBMT no. 212); Ospedale San Martino, Genova, Italy (EBMT no. 217); Royal Marsden Hospital, London, UK (EBMT no. 218); University College, qLondon, UK (EBMT no. 224); Cliniques Universitaires St Luc, Brussels, Belgium (EBMT no. 234); University Medical Center St Radboud, Nijmegen, The Netherlands (EBMT no. 237); University Medical Centre, Utrecht, The Netherlands (EBMT no. 239); Great Ormond Street Hospital, London, UK (EBMT no. 243); Glasgow Royal Infirmary, Glasgow, UK (EBMT no. 244); St James' University Hospital, Leeds, UK (EBMT no. 254); Hopital Cantonal Universitaire, Geneva, Switzerland (EBMT no. 261); Birmingham Heartlands Hospital, Birmingham, UK (EBMT no. 284); University of Wales Hospital, Cardiff, UK (EBMT no. 303); Ottawa General Hospital, Ottawa, Canada (EBMT no. 351); Bristol Royal Hospital for Children, Bristol, UK (EBMT no. 386); University Hospital Birmingham NHS Trust, Queen Elizabeth Medical Centre, Birmingham, UK (EBMT no. 387); Royal Liverpool University Hospital, Liverpool, UK (EBMT no. 501); Royal Manchester Children's Hospital, Manchester, UK (EBMT no. 521); St George's Hospital, London, UK (EBMT no. 539); University Children's Hospital, Graz, Austria (EBMT no. 593); Manchester Royal Infirmary, Manchester, UK (EBMT no. 601); University Hospital VUB, Brussels, Belgium (EBMT no. 630); Onkozentrum, Zurich, Switzerland (EBMT no. 700); Royal Perth Hospital, Perth, Australia (EBMT no. 710); Leicester Royal Infirmary, Leicester, UK (EBMT no. 713); Nottingham City Hospital, Nottingham, UK (EBMT no. 717); Christie NHS Trust Hospital, Manchester, UK (EBMT no. 780); Birmingham Children's Hospital, Birmingham, UK (EBMT no. 781).

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Hows, J., Passweg, J., Tichelli, A. et al. Comparison of long-term outcomes after allogeneic hematopoietic stem cell transplantation from matched sibling and unrelated donors. Bone Marrow Transplant 38, 799–805 (2006). https://doi.org/10.1038/sj.bmt.1705531

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