Bone marrow transplantation unrelated donors

Ochs, L. et al., Late infections after allogeneic bone marrow transplantations comparison of incidence in related and unrelated donor transplant recipients, Blood, 86, 3979, 1995. 

Small, T.N. et al., Comparison of immune reconstitution after unrelated and related T-cell-depleted bone marrow transplantation effect of patient age and donor leukocyte infusions,... 

Gajewski J, GJertson D, Cecka M et al. The impact of T cell depletion on the effects of HLA-DRBl and DQB allele matching in HLA serologically identical unrelated donor bone marrow transplantation. Biol. Blood Marrow Transplant 1997 3 76-82... 

Przepiorka D, Petropoulos D, Mullen C et al. Tacrolismus for prevention of graft-versus-host-disease after mismatched unrelated donor cord blood transplantation. Bone Marrow Transplantation 1999 23 1291-1295... 

Bunin N, Aplenc R, Leahey A, Magira E, Grupp S, Pierson G, Monos D. Outcomes of transplantation with partial T-cell depletion of matched or mismatched unrelated or partially matched related donor bone marrow in children and adolescents with leukemias. Bone Marrow Transplant 2005 35 151-8. 

Mao P, Liao C, Zhu Z, Wang H, Wang S, Xu Y, Mo W, Ying Y, Li Q, Liu B. Umbilical cord blood transplantation from unrelated HLA-matched donor in an adult with severe aplastic anemia. Bone Marrow Transplant 2000 26(10) 1121-3. 

Grafts of PBPCs from unrelated donors are also increasingly used for transplantation. The cells are collected by leukapheresis after mobilization of PBPCs by giving the donor G-CSF. This spares the donor from potential complications related to general or spinal anesthesia and pain associated with bone marrow harvest. Unrelated PBPC transplants are associated with more rapid engraftment compared to unrelated BMT, with no increase in GVHD or relapse rates. ... 

HLA human leukocyte antigen HSCT hematopoietic stem cell transplantation hyper-CVAD high-dose methotrexate and cytarabine alternating with fractionated cyclophosphamide plus vincristine, doxorubicin, and dexamethasone IBMTR International Bone Marrow Transplant Registry IL-2 interleukin-2 MDS myelodysplastic syndrome MLL mixed lineage leukemia MUD matched unrelated donor NCCN National Comprehensive Cancer Network NST nonmyeloablative stem cell transplant OS overall survival Ph+ Philadelphia chromosome PML promyelocytic leukemia (gene)... 

Hansen J, Goolby TA, Martin PJ, et al. Bone marrow transplantation from unrelated donors for patients with chronic myelogenous leukemia. N Engl J Med 1998 338 962-968. 

Weisdorf DJ, Anasetti C, Antin JH, et al. Allogeneic bone marrow transplantation for chronic myelogenous leukemia comparative analysis of unrelated versus matched sibUng donor transplantation. Blood 2002 99 1971-1977. 

Lee SJ, Kuntz KM, Horowitz MM, et al. Unrelated donor bone marrow transplantation for chronic myelogenous leukemia A decision analysis. Ann Intern Med 1997 127 1080-1088. 

Flomenberg N, Baxter-Lowe LA, Confer D, et al. Impact of HLA class I and class II high resolution matching on outcomes of unrelated donor bone marrow transplantation HLA-C mismatching is associated with a strong adverse effect on transplant outcome. Blood 2004 104 1923— 1930. 

In Asia the figure is slightly higher (H4). However, between 60 and 70% of patients who might otherwise benefit from a bone marrow transplant are deprived of the opportunity because no HLA-matched sibling donor is available. To overcome this problem, many centers have turned their attention to the use of HLA-matched unrelated bone marrow donors and partially matched family members. 

B6. Beatty, P. G., Ash, R., Hows, J. M., and McGlave, P. B. The use of unrelated bone marrow donors in the treatment of patients with chronic myelogenous leukemia Experience of four marrow transplant centers. Bone Marrow Transplant. 4, 287-290 (1989). 

Cord blood is used as an alternative source of hemopoietic stem cells, with the potential advantage that it has less-stringent requirements for HLA matching than hematopoietic stem cells from an adult unrelated donor. Because the neonatal immune system is naive, transplantation of cord blood stem cells yields a lower incidence of acute and chronic GVHD [99 100 =,101 =,102 =,103, 104 ]. The low expression of co-stimulatory molecules on cord blood stem cells could contribute to the lower risk of rejection by the immune system compared with bone marrow transplantation [99 ]. A potential disadvantage of cord blood stem cells is that immune reconstitution is substantially delayed compared with bone marrow transplantation, making recipients more susceptible to... 

A 48-year-old man with myelodysplastic syndrome underwent bone marrow transplantation from an unrelated donor and took... 

Zhang H, Chen J, Que W. A meta-analysis of unrelated donor umbilical cord blood transplantation versus unrelated donor bone marrow transplantation in acute leukemia patients. Biol Blood Marrow Transpl 2012 18(8) 1164-73. 

In addition to bone marrow and peripheral blood, hematopoietic stem cells are also found in umbihcal cord blood (UCB). UCB is an attractive source for several reasons. Because the stem cells are collected from placental blood, there is no risk to the mother or the baby. There is also very low risk of hansmissible infectious diseases such as cytomegalovhus and Epstein-Barr virus. In addition, the cells are available immediately because the donor does not have to be located and harvested. Initially, UCB was obtained from sibhngs but now recipients of transplants from unrelated donors accountfor almost all patients who receive UCB transplants. It is estimated that more than 2,000 unrelated UCB transplants have been performed worldwide. ... 

UCB represents an alternative source of hematopoietic stem cells in children and some adults who do not have a HLA-matched sibling donor. As discussed above, UCB has some advantages over bone marrow stem cells. In addition, the time required to identify and obtain cells from an unrelated UCB donor is usually less than 1 month, which is significantly shorter than that required for an unrelated marrow donor. Therefore a UCB graft may be advantageous for patients who require an urgent transplant. 

Barker JN, Davies SM, DeEor TE, et al. Survival after transplantation of unrelated donor umbilical cord blood is comparable to that of human leukocyte antigen-matched-unrelated donor bone marrow results of a matched-pair analysis. Blood 2001 97 2957-2961. 

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