FACTORS INFLUENCING THE OUTCOME OF DONOR MARROW TRANSPLANTATION IN ADULTS FROM LESS-THAN IDEAL DONORS - EXPERIENCE FROM 2 AUSTRALIAN CENTERS

Background: This paper reports the results of 78 marrow transplants in two Australian hospitals between 1991 and 1996, using unrelated (n=54 ) or mismatched related (n=24) donors. Twenty-six patients received gr anulocyte-macrophage colony stimulating factor (GM-CSF) post-transplan t as part of a phase II study. Fifty-four patients (74%) had advanced disease. Aims: To identify factors associated with a superior outcome post-transplant, to evaluate the effect of GM-CSF on engraftment and o ther transplant parameters, and to compare the overall results with th ose of published series. Methods: Review of patient records, a Medline search of the relevant literature and appropriate statistical analysi s. Results: The probability of overall survival and event-free surviva l (EFS) at three years was 35+/-6% and 22+/-6% respectively. Pre-trans plant factors significantly associated with an inferior EFS were advan ced disease, poorer performance status and age >30 years. The EFS in p atients with standard risk disease was 51+/-13% versus 10+/-5% in pati ents with advanced disease, p<0.0001. Severe acute graft-versus-host d isease was also associated with a poorer outcome. Neutrophil engraftme nt was faster in patients who received GM-CSF but there was no differe nce in any other transplant parameters. Conclusions: These results are consistent with reported series elsewhere and suggest that an extende d family or unrelated donor transplant should generally be limited to patients with a good performance status and early phase but otherwise incurable haematological disease.