BONE-MARROW TRANSPLANTS FROM UNRELATED DONORS FOR PATIENTS WITH CHRONIC MYELOID-LEUKEMIA

Background Chronic myeloid leukemia can be cured by marrow transplanta tion from an HLA-identical sibling donor. The use of transplants from unrelated donors is an option for the 70 percent of patients without a n HLA-identical sibling, but the morbidity and mortality associated wi th such transplants have been cause for concern. We analyzed the safet y and efficacy of transplants from unrelated donors for the treatment of chronic myeloid leukemia and identified variables that predict a fa vorable outcome. Methods Between May 1985 and December 1994, 196 patie nts with Philadelphia chromosome-positive chronic myeloid leukemia in chronic phase received marrow transplants from unrelated donors. Resul ts The median follow-up was 5 years (range, 1.2 to 10.1). Graft failur e occurred in 5 percent of patients wile could be evaluated. Acute gra ft-versus-host disease of grade III or IV severity was observed in 35 percent of patients who received HLA-matched transplants, and the esti mated cumulative incidence of relapse at five years was 10 percent. Th e Kaplan-Meier estimate of survival at five years was 57 percent. Surv ival was adversely affected by an interval from diagnosis to transplan tation of one year or more, an HLA-DRB1 mismatch, a high body-weight i ndex, and an age of more than 50 years. Survival was improved by the p rophylactic use of fluconazole and ganciclovir. The Kaplan-Meier estim ate of survival at five years was 74 percent (95 percent confidence in terval, 62 to 86 percent) for patients who were 50 years of age or you nger who received a transplant from an HLA-matched donor within one ye ar after diagnosis. Conclusions Transplantation of marrow from an HLA- matched, unrelated donor is safe and effective therapy for selected pa tients with chronic myeloid leukemia. (C)1998, Massachusetts Medical S ociety.