DONOR SEARCH OR AUTOGRAFTING IN PATIENTS WITH ACUTE-LEUKEMIA WHO LACKAN HLA-IDENTICAL SIBLING - A MATCHED-PAIR ANALYSIS

One hundred and ninety-one patients with acute leukaemia who received bone marrow from HLA-A, -B and -DR identical unrelated donors and were reported to EBMT and/or IMUST, were matched with 382 patients receivi ng autologous bone marrow for diagnosis, age, stage of disease and yea r of transplantation. Transplant-related mortality (TRM) was significa ntly higher in recipients of unrelated marrow compared to autograft re cipients, 44+/-4% (+/-95% confidence interval) and 15+/-3% at 2 years in the two groups, respectively (P <10(-4)). In contrast, relapse prob ability was lower in recipients of unrelated marrow, being 32+/-5% at 2 years compared to 55+/-3% in recipients of autografts (P <10(-4)). T wo-year leukaemia-free survival (LFS) in patients with acute lymphobla stic leukaemia was 39+/-5% and 32+/-3% in the two groups, respectively , Among patients with acute myeloid leukaemia (AML), the corresponding figures were 36+/-6% and 46+/-5% in the two groups, respectively (P=N S). In AML in first remission (CR-1), the 2-year survival was 42+/-10% in recipients of unrelated bone marrow, compared to 69+/-8% in autogr aft recipients (P=0.008). When all patients with acute leukaemia were included, the 2-year LFS was 38% in recipients of unrelated marrow, co mpared to 37% in autograft recipients (NS). In conclusion, this retros pective analysis supports the design of a prospective randomized study in patients with high-risk/advanced acute leukaemia who lack a suitab le related bone marrow donor, to ascertain which of the two strategies , if any, should be favoured.