Low transplant-related mortality in patients receiving unrelated donor marrow grafts for leukemia

Transplantation,vith unrelated donor (UD) marrow has been shown to potentia lly cure patients with leukemia. Between January 1991 and April 1998, 54 pa tients with leukemia have received an UD BMT at our institution. Five patie nts received their UD BMT as a second transplant after a preceding autologo us or syngeneic BMT and were excluded from further analysis. Forty-nine pat ients with leukemia (acute leukemia n = 26; CML n = 23) and a median age of 36 years (range 19-51) were analyzed, For conditioning, all patients recei ved a combination of fractionated TBI and CY. GVHD prophylaxis consisted of MTX and CsA in all patients. As of 30 April 1998, 27 of 49 (55%) patients survive after a median observation time of 18 months. The probability of ov erall survival for standard risk and high risk patients is 54% and 31% (P = 0.05). Probability of transplant-related mortality (TRM) is 27%, 24% in st andard risk and 31% in high risk patients (P = 0.44). Patients younger than 40 years (n = 33) had a similar TRM as patients 40 years and older (n = 16 ). The probability of relapse is 41% for the whole group, 29% for standard risk and 55% for high risk pts (P < 0.05). Our data confirm that UD BMT is an effective treatment for patients with leukemia. TRM is almost similar to related sibling BMT, most probably due to improvements in HLA typing techn ology, conditioning regimen and supportive patient care.