BONE-MARROW TRANSPLANTATION IN CHILDREN USING UNRELATED DONORS AT HUDDINGE-HOSPITAL

Twenty-eight out of 31 children that underwent bone marrow transplanta tion (BMT) from unrelated donors between 1984 and 1995 received HLA-A, HLA-B and HLA-DR matched unrelated donor (MUD) marrows as defined by serologic HLA class I and genomic HLA class II typing. Compared with 2 8 case-matched controls transplanted with HLA identical sibling donors , MUD patients received a more intensive conditioning. Twenty-six pati ents (93%) engrafted while two died of septicaemia during the aplastic phase. Two patients rejected their grafts and four developed Evans sy ndrome. All controls engrafted without incidents of rejection or Evans syndrome. The probability of acute graft-versus-host disease (GVHD) o f grade II or above was 27% after MUD-BMT and 7% in the controls. The 5-year probability of survival was 60% in MUD patients and 89% after s ibling BMT (p = 0.03). Leukaemia-free survival was 60% with one relaps e in the MUD patients, and 59% with five relapses in the sibling group . Three children who received a mismatched donor marrow died, two of s evere GVHD and one after graft rejection. In conclusion, today, a matc hed unrelated donor BMT is an acceptable alternative for many children who need a BMT but lack a suitable related donor.