Feasibility and timing of unrelated donor identification for patients with ALL

Patients with relapsed ALL frequently have short duration second or later remissions, leaving only a brief window of time when it is possible to perform BMT. When no sibling donor is available, identifying and unrelated donor in a timely fashion can be difficult while autologous BMT (ABMT) can be performed more quickly. We have studied the outcome of 115 consecutive referrals of patients with ALL to the University of Minnesota for BMT between September 1991 and August 1993 to determine the feasibility of URD identification and BMT in these patients. In 40 cases (35%) a related allogeneic donor was identified and 30 of these patients received BMT at Minnesota. Our policy for patients with no related donor (n = 75) was to initiate an unrelated donor (URD) search and seek insurance authorization for both URD and ABMT immediately on referral; URD BMT is offered if a donor is available within 4 months. Thereafter ABMT is offered if an URD is no yet available. Fifty-eight patients (50% of referrals) initiated an URD search. An URD was identified for 22 patients (37%) of searches) and 15 patients (13% of referred patients) received URD BMT. The median time from patient referral to donor identification was 10 weeks. Nineteen percent of referred patients died prior to transplant despite all efforts to expedite BMT. Further efforts are needed to speed the process of donor selection for patients with ALL. Clinical risk factors (eg leukocyte count, cytogenetics), patient age and donor histocompatibility need to be integrated for proper patient counseling and therapeutic choices.