Analysis of 462 Transplantations from Unrelated Donors Facilitated by the National Marrow Donor Program

Abstract

Background and Methods: Allogeneic bone marrow transplantation is curative in a substantial number of patients with hematologic cancers, marrow-failure disorders, immunodeficiency syndromes, and certain metabolic diseases. Unfortunately, only 25 to 30 percent of potential recipients have HLA-identical siblings who can act as donors. In 1986 the National Marrow Donor Program was created in the United States to facilitate the finding and procurement of suitable marrow from unrelated donors for patients lacking related donors. Results: During the first four years of the program, 462 patients with acquired and congenital lymphohematopoietic disorders or metabolic diseases received marrow transplants from unrelated donors. The probability of engraftment by 100 days after transplantation was 94 percent, although 8 percent of patients later had secondary graft failure. The probability of grade II, III, or IV acute graft-versus-host disease was 64 percent, and the probability of chronic graft-versus-host disease at one year was 55 percent. The rate of disease-free survival at two years among patients with leukemia and good prognostic factors was 40 percent and among patients at higher risk, 19 percent. Twenty-nine percent of the patients with aplastic anemia were alive at two years, and the rate of two-year disease-free survival among patients with myelodysplasia was 18 percent. For patients with congenital immunologic or nonimmunologic disorders, the probability of survival was 52 percent. Conclusions: The National Marrow Donor Program has benefited a substantial number of patients in need of marrow transplants from closely HLA-matched unrelated donors and has facilitated the recruitment of unrelated donors into the donor pool and the access to suitable marrow., Allogeneic marrow transplantation is an accepted form of treatment that can provide a cure for patients with hematologic cancers, syndromes of bone marrow failure, and congenital disorders of the lymphohematopoietic system 1 , 2 . This type of treatment, however, has largely been restricted to patients with an HLA-identical family member who is willing to be a donor 3 . To extend marrow transplantation to patients who could benefit from an allogeneic marrow transplant, but who lack a suitably HLA-matched related donor, several investigators have explored the use of other sources of marrow, including partially HLA-matched family members and unrelated donors who are… © 1993, Massachusetts Medical Society. All rights reserved.