ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR CHRONIC MYELOID-LEUKEMIA USING SIBLING AND VOLUNTEER UNRELATED DONORS - A COMPARISON OF COMPLICATIONS IN THE 1ST 2 YEARS

Objective: To compare the short- and medium-term complications (partic ularly infection) of bone marrow transplantation for chronic myeloid l eukemia in patients with HLA-identical sibling donors or volunteer unr elated donors. Design: Retrospective review of two cohorts of patients . Setting: Tertiary referral center. Patients: One hundred three patie nts with chronic myeloid leukemia in first chronic phase. Intervention : Patients were treated with bone marrow transplantation using marrow from HLA-identical siblings (n = 57) and volunteer donors (n = 46). Ma in Results: In total, 68 patients survived a median of 22 months from bone marrow transplant (range, 7 to 81 months). The actuarial probabil ities of overall survival and leukemia-free survival at 2 years for th e sibling donor group were 73% (95% CI, 60% to 86%) and 72% (CI, 60% t o 84%), respectively, and for the volunteer donor group, 47% (CI, 31% to 63%) and 42% (CI, 26% to 58%) (P = 0.07 and 0.05, respectively). Ho wever, after adjustment for duration of disease, overall and disease-f ree survival in the two donor groups did not differ significantly. A m ajor problem was an increased incidence of severe viral infection in t he volunteer unrelated donor group (19 episodes in 16 of 46 patients c ompared with 7 episodes in 7 of 57 sibling donor patients, P = 0.01). The actuarial incidence of chronic graft-versus-host disease (GVHD) wa s higher in volunteer unrelated donor patients (77% [CI, 63% to 91%] c ompared with 49% [CI, 35% to 63%]; P = 0.02) but that of acute GVHD wa s not. The median performance status of the survivors in the volunteer donor group is similar to that in the sibling donor group. The incide nce of hematologic relapse in both groups so far is low. Conclusion: R esults appear to justify the continued use of volunteer donors in chro nic-phase chronic myeloid leukemia, but infection and chronic GVHD are still major problems.