BONE-MARROW TRANSPLANTATION FROM PARTIALLY HLA-MATCHED RELATED DONORSIN ADULTS WITH LEUKEMIA - THE EXPERIENCE AT THE UNIVERSITY-HOSPITAL-OF-ESSEN, GERMANY

The Seattle group has demonstrated that bone marrow transplantation (B MT) using partially HLA-mismatched related donors is feasible in princ ipal. However, it was unclear whether these results can also be achiev ed at smaller-sized BMT units. Therefore a matched pair analysis enrol ling 52 BMTs from partially HLA-mismatched relatives and 52 control BM Ts from HLA-identical siblings was performed at the University Hospita l of Essen. Overall survival (OS) and incidence of graft-versus-host d isease (GVHD) did not differ significantly after study and control BMT s (OS: 52% v 63% 1 year, 46% v 48% 5 years post transplant; acute GVHD : 37% v 35%, chronic GVHD: 67% v 55%). After study BMTs, however, ther apy-related mortality (P=0.018) and incidence of graft failure (P=0.00 2) were increased, whereas relapse rate was reduced (11% v 27%). Two o r three mismatches in HVG direction implied the same risk of graft fai lure as one mismatch, Therefore. (i) OS after BMT from one HLA antigen mismatched relative and from HLA-identical siblings does riot differ significantly even when performed at a 'smaller' centre: (ii) two or e ven three HLA mismatches in host-versus graft (HVG) direction might be acceptable in family BMT for leukaemia.