Related Experiment Videos
[A preliminary analysis of unrelated marrow transplantations facilitated by the Japan Marrow Donor Program (JMDP)]
Insights
Unrelated donor marrow transplants offer effective treatment for hematologic disorders, with a 50% survival rate at 1.5 years. Graft failure and acute graft-versus-host disease (GVHD) risks were observed.
Area of Science:
- Hematology
- Immunology
- Oncology
Background:
- The John's Marrow Donor Program (JMDP) facilitated unrelated donor marrow transplants for patients with malignant and non-malignant disorders.
- The study included 171 patients, with a median age of 21 years, receiving marrow from HLA-identical unrelated donors.
Purpose of the Study:
- To evaluate the efficacy and outcomes of unrelated donor marrow transplantation.
- To assess the incidence of graft failure, graft-versus-host disease (GVHD), and overall survival.
Main Methods:
- Patients received marrow from phenotypically HLA-A, -B, -DR identical unrelated donors.
- Conditioning regimens included total body irradiation (TBI) for about half the patients.
- Graft-versus-host disease (GVHD) prophylaxis involved methotrexate and cyclosporine in approximately 80% of patients.
Main Results:
- Graft failure occurred in 4.7% of patients.
- Grade II-IV acute GVHD developed in 44% of patients surviving over 30 days.
- Chronic GVHD occurred in 47% of patients, with 27% having the extensive form. Moderate to severe acute GVHD was more frequent than in sibling transplants, while chronic GVHD rates were similar.
Conclusions:
- Unrelated donor marrow transplantation is a viable treatment option for specific hematologic disorders.
- Despite risks of graft failure and acute GVHD, overall survival at 1.5 years was approximately 50%.
- Age significantly impacted survival in standard-risk leukemia patients.
Abstract:
Between January 1993 and June 1994, the JMDP facilitated marrow donations from unrelated donors for 171 patients with malignant and non-malignant disorders. The median age of the patients was 21 years. All patients received marrow from phenotypically HLA -A, -B, -DR identical donors. About half of the patients wrer treated with total body irradiation (TBI)-containing regimens and about 80% of the patients received short-courses methotrexate and cyclosporine for graft-versus-host disease (GVHD) prophylaxis. Eight out of 171 patients, (4.7%) had graft failure and 63 out of 144 patients (44%), who survived for more than 30 days posttransplant, developed grade II to IV acute GVHD. The incidence of chronic GVHD was 47% (extensive form; 27%); most of them were progressive/quiscent type. The incidence of moderate to severe acute GVHD was higher than that observed in sibling transplants. On the other hand, the incidence of chronic GVHD was similar to that observed in sibling transplants. Overall survival at 1.5 years posttransplant was about 50% with no significant differences between diseases. The age correlated significantly with the survival in standard risk leukemia but not in high-risk leukemia. Despite the risk of graft failure and acute GVHD, this preliminary analysis demonstrates that transplantation of marrow from unrelated donors can be an effective treatment for certain hematologic disorders.