OUTCOMES OF TRANSPLANTATION WITH MATCHED-SIBLING AND UNRELATED-DONOR BONE-MARROW IN CHILDREN WITH LEUKEMIA

Background For most conditions amenable to bone-marrow transplantation , grafts from HLA-matched but unrelated donors have yielded poorer res ults than those obtained from matched-sibling donors, We assessed this pattern in the light of improvements in donor selection and posttrans plant supportive care. Methods We reviewed transplant outcome in 103 w ith childhood leukaemia who bone-marrow transplantation with HLA-match ed sibling marrow (n=52) or matched unrelated donor marrow (n=51) betw een May, 1990, and March, 1996, at St Jude Children's Research Hospita l. Findings Analysis of engraftment, frequency of procedure-related co mplications, and disease-free survival revealed no advantage from use of matched-sibling marrow, The 2-year disease-free survival estimate f or standard-risk recipients of matched-sibling marrow was 81 [8.1]% co mpared with 73 [12.1]% in the unrelated donor marrow group (p=0.77), I n the high-risk category, patients with a matched-sibling donor had a 2-year disease-free survival of 31 [11.6]%, compared with 32 [15.1]% a mong recipients of matched unrelated donor marrow (p=0.87).Interpretat ion We believe this improved result with unrelated donor marrow is a c onsequence of recent innovations in histocompatibility matching, preve ntion of graft-versus-host disease (GvHD), and antiviral prophylaxis. We suggest that such grafts can now be used in patients at both standa rd and high risk without compromising treatment outcome.