Faculty Collaboration Database

Engraftment and survival after unrelated-donor bone marrow transplantation: a report from the national marrow donor program. Blood 2000 Dec 15;96(13):4096-102

Date

12/09/2000

Pubmed ID

11110679

Scopus ID

2-s2.0-0034672165 (requires institutional sign-in at Scopus site)   198 Citations

Abstract

We analyzed engraftment of unrelated-donor (URD) bone marrow in 5246 patients who received transplants facilitated by the National Marrow Donor Program between August 1991 and June 1999. Among patients surviving at least 28 days, 4% had primary graft failure (failure to achieve an absolute neutrophil count > 5 x 10(8)/L before death or second stem-cell infusion). Multivariate logistic regression analysis showed that engraftment was associated with marrow matched at HLA-A, HLA-B, and DRB1; higher cell dose; younger recipient; male recipient; and recipient from a non-African American ethnic group. More rapid myeloid engraftment was associated with marrow serologically matched at HLA-A and HLA-B, DRB1 match, higher cell dose (in non-T-cell-depleted cases), younger recipient, recipient seronegativity for cytomegalovirus (CMV), male donor, no methotrexate for graft-versus-host disease prophylaxis, and transplantation done in more recent years. A platelet count higher than 50 x 10(9)/L was achieved by 47% of patients by day 100. Conditional on survival to day 100, survival at 3 years was 61% in those with platelet engraftment at day 30, 58% in those with engraftment between day 30 and day 100, and 33% in those without engraftment at day 100 (P <.0001). Factors favoring platelet engraftment were higher cell dose, DRB1 allele match, recipient seronegativity for CMV, HLA-A and HLA-B serologically matched donor, and male donor. Secondary graft failure occurred in 10% of patients achieving initial engraftment, and 18% of those patients are alive. These data demonstrate that quality of engraftment is an important predictor of survival after URD bone marrow transplantation.

Author List

Davies SM, Kollman C, Anasetti C, Antin JH, Gajewski J, Casper JT, Nademanee A, Noreen H, King R, Confer D, Kernan NA

Author

James Casper MD Emeritus Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Age Factors
Aged
Bone Marrow Transplantation
Child
Child, Preschool
Combined Modality Therapy
Comorbidity
Cytomegalovirus Infections
Female
Genetic Diseases, Inborn
Graft Survival
Graft vs Host Disease
Hematologic Diseases
Histocompatibility
Humans
Infant
Leukemia
Life Tables
Male
Middle Aged
Multivariate Analysis
Neoplasms
Platelet Count
Proportional Hazards Models
Registries
Retrospective Studies
Risk Factors
Sex Factors
Survival Analysis
Time Factors
Transplantation Conditioning
United States