UNRELATED DONOR MARROW TRANSPLANTATION - INITIAL EXPERIENCE OF THE ITALIAN BONE-MARROW TRANSPLANT GROUP (GITMO)

From 1 September 1988 to 30 September 1993, a search for an unrelated donor (URD) was started for 633 Italian patients. Eighty-five of them (13%) were transplanted. Despite the introduction of more strict crite ria for the selection of compatible donors, the percentage of patients who reached transplant increased significantly after December 1992. F or patients who started a search before and after January 1993, respec tively the probability of transplant by 8 and 16 months from search ac tivation was 4 and 10%, compared to 22 and 37% (P = 0.0001). The avera ge intervals between search activation and graft were 15 and 8 months respectively, for the first and second group (P = 0.0001). Data of 75 consecutive transplants performed up to March 1994 were analyzed. Actu arial 2-year survival was 15% for patients grafted before 1992 and 40% for those grafted after January 1992. In this latter period, survival of patients with malignant and non-malignant disorders was 32 and 67% , respectively. In univariate analysis, patients younger than 16 years (P = 0.01), patients grafted after 1992 (P = 0.01) and patients recei ving the marrow from a 6-antigen matched donor (P = 0.01) showed a hig her survival probability. Multivariate analysis did not show any diffe rence, probably due to the low number of patients and to short follow- up. The adoption of stricter and more accurate HLA-matching criteria a nd the consequent reduction of deaths related to acute GVHD were the m ain reasons for the improvement of survival observed in patients graft ed after 1992.