Unrelated donor marrow transplantation: an update of the experience of theItalian Bone Marrow Transplant Group (GITMO)

Background and Objectives. Unrelated donor bone marrow transplant (UD BMT) has become an attractive alternative source of hematopoietic cells for pati ents lacking a matched sibling. The aim of this paper was to report on resu lts of the 696 UD BMTs performed in 31 Italian institutions during the firs t 10 years of activity of the Italian Bone Marrow Donor Registry (IBMDR). Evidence and Information Sources. In 1989 the Italian Bone Marrow Transplan t Group (GITMO) established the IBMDR to facilitate donor search and marrow procurement for patients lacking an HLA identical sibling. By the end of D ecember 1999, 260,000 HLA-A, B typed volunteer donors had been cumulatively registered and 2,620 searches had been activated for Italian patients, At least one HLA-A, B, DRB1 matched donor was found for 54% of the patients an d 696 UD BMTs were performed. In 50% of cases the donor was found in the IB MDR and in 50% in 15 other Registries. The average time from search activat ion to transplant was 6 months for disease other than CML For CML it was 14 months. Actuarial 12-month transplant-related mortality (TRM) was 68% in p atients grafted between 1979 and 1992 and 44% for patients grafted after 19 93, Twenty-eight per cent of patients developed grade III or IV acute GvHD and 24% developed extensive chronic GvHD, The rate of disease free survival at three years was 57% for patients with 1(st) chronic phase CML, 37% for patients with 1(st) or 2(nd) CR ALL, 31% for AML or MDS patients less than or equal to 18 years of age and 54% far patients with inborn errors. Perspectives. We conclude that the IBMDR has benefited a substantial number of patients lacking a matched sibling and has facilitated the recruitment of UDs into the international donor pool. The long time required for the se arch is the major obstacle to the success of this program. This suggests th at early transplant and a decrease in TRM could further improve these encou raging results.(C) 2000, Ferrata Storti Foundation.