Between January 1989 and July 1995 the search for an unrelated donor (UD) was started for 379 consecutive Italian patients with Philadelphia positive (Ph+) chronic myelogenous leukaemia (CML). 89 (23%) were transplanted. The overall probability of transplant before and after December 1991 was 16% and 49% respectively (P= 0.0001), and average interval between search activation and graft was 23 months and 13 months, respectively (P=O.0001). Disease-free survival (DFS) following 60 consecutive transplants performed before February 1996 was 41.5% at 48 months and was 64% for patients grafted after January 1993. In univariate analysis, five variables had a favourable effect on DFS: year of bone marrow transplantation (BMT) after 1993 (P=0.0002), HLA-DRB1 donor/recipient (D/R) match (P= 0.0006), total body irradiation (TBI) containing regimen (P=0.0006), graft-versus- host disease (GvHD) prophylaxis including 'early' cyclosporin before the transplant, and a marrow cell dose > 3 x 108/kg of recipient body weight (P=0.04). Multivariate analysis confirmed that HLA identity (P=0.006), TBI- containing regimen (P= 0.0001) and 'early cyclosporin' (P=0.04) were associated with higher DFS. Transplant-related mortality (TRM) was 67% in patients grafted before January 1993 and 30% in patients grafted subsequently (P = 0.002). Multivariate analysis confirmed DRB1 identity (P=0.03) and TBI- containing regimen (P = 0.0005) to be independent factors predictive of low TRM. This suggests that the outcome of patients transplanted from an HLA DRB1 matched donor, after a TBI-containing preparative regimen, is similar to results recently reported in patients transplanted from geno-identical siblings. These results indicate that the search should be initiated at diagnosis for patients < 45 years of age and UD BMT should be considered early in the disease course for those with an available DRB1-matched unrelated donor.

Unrelated donor marrow transplantation for chronic myelogenous leukaemia / Dini, G.; Lamparelli, T.; Rondelli, R.; Lanino, R.; Barbanti, M.; Costa, C.; Manfredini, L.; Guidi, S.; Rosti, G.; Alessandrino, E. P.; Locatelli, F.; Marenco, P.; Soligo, D.; Di Bartolomeo, P.; Aversa, F.; La Nasa, G.; Busca, A.; Majolino, I.; De Laurenzi, A.; Bacigalupo, A.. - In: BRITISH JOURNAL OF HAEMATOLOGY. - ISSN 0007-1048. - 102:2(1998), pp. 544-552. [10.1046/j.1365-2141.1998.00790.x]

Unrelated donor marrow transplantation for chronic myelogenous leukaemia

Locatelli F.;
1998

Abstract

Between January 1989 and July 1995 the search for an unrelated donor (UD) was started for 379 consecutive Italian patients with Philadelphia positive (Ph+) chronic myelogenous leukaemia (CML). 89 (23%) were transplanted. The overall probability of transplant before and after December 1991 was 16% and 49% respectively (P= 0.0001), and average interval between search activation and graft was 23 months and 13 months, respectively (P=O.0001). Disease-free survival (DFS) following 60 consecutive transplants performed before February 1996 was 41.5% at 48 months and was 64% for patients grafted after January 1993. In univariate analysis, five variables had a favourable effect on DFS: year of bone marrow transplantation (BMT) after 1993 (P=0.0002), HLA-DRB1 donor/recipient (D/R) match (P= 0.0006), total body irradiation (TBI) containing regimen (P=0.0006), graft-versus- host disease (GvHD) prophylaxis including 'early' cyclosporin before the transplant, and a marrow cell dose > 3 x 108/kg of recipient body weight (P=0.04). Multivariate analysis confirmed that HLA identity (P=0.006), TBI- containing regimen (P= 0.0001) and 'early cyclosporin' (P=0.04) were associated with higher DFS. Transplant-related mortality (TRM) was 67% in patients grafted before January 1993 and 30% in patients grafted subsequently (P = 0.002). Multivariate analysis confirmed DRB1 identity (P=0.03) and TBI- containing regimen (P = 0.0005) to be independent factors predictive of low TRM. This suggests that the outcome of patients transplanted from an HLA DRB1 matched donor, after a TBI-containing preparative regimen, is similar to results recently reported in patients transplanted from geno-identical siblings. These results indicate that the search should be initiated at diagnosis for patients < 45 years of age and UD BMT should be considered early in the disease course for those with an available DRB1-matched unrelated donor.
1998
Bone marrow transplantation; CML; Marrow donor registries; Unrelated BMT
01 Pubblicazione su rivista::01a Articolo in rivista
Unrelated donor marrow transplantation for chronic myelogenous leukaemia / Dini, G.; Lamparelli, T.; Rondelli, R.; Lanino, R.; Barbanti, M.; Costa, C.; Manfredini, L.; Guidi, S.; Rosti, G.; Alessandrino, E. P.; Locatelli, F.; Marenco, P.; Soligo, D.; Di Bartolomeo, P.; Aversa, F.; La Nasa, G.; Busca, A.; Majolino, I.; De Laurenzi, A.; Bacigalupo, A.. - In: BRITISH JOURNAL OF HAEMATOLOGY. - ISSN 0007-1048. - 102:2(1998), pp. 544-552. [10.1046/j.1365-2141.1998.00790.x]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1491115
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