Premium
Factors influencing the outcome of donor marrow transplantation in adults from less than ideal donors: experience from two Australian centres
Author(s) -
Grigg A.,
Morton J.,
Durrant S.,
Bardy P.,
Szer J.
Publication year - 1997
Publication title -
australian and new zealand journal of medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 0004-8291
DOI - 10.1111/j.1445-5994.1997.tb01984.x
Subject(s) - medicine , disease , transplantation , surgery , pediatrics
Background: This paper reports the results of 78 marrow transplants in two Australian hospitals between 1991 and 1996, using unrelated ( n =54) or mismatched related ( n =24) donors. Twenty‐six patients received granulocyte‐macrophage colony stimulating factor (GM‐CSF) post‐transplant as part of a phase II study. Fifty‐four patients (74%) had advanced disease. Aims: To identify factors associated with a superior outcome post‐transplant, to evaluate the effect of GM‐CSF on engraftment and other transplant parameters, and to compare the overall results with those of published series. Methods: Review of patient records, a Medline search of the relevant literature and appropriate statistical analysis. Results: The probability of overall survival and event‐free survival (EFS) at three years was 35 ±6% and 22±6% respectively. Pre‐transplant factors significantly associated with an inferior EFS were advanced disease, poorer performance status and age >30 years. The EFS in patients with standard risk disease was 51 ±13% versus 10±5% in patients with advanced disease, p <.0001. Severe acute graft‐versus‐host disease was also associated with a poorer outcome. Neutrophil engraftment was faster in patients who received GM‐CSF but there was no difference in any other transplant parameters. Conclusions: These results are consistent with reported series elsewhere and suggest that an extended family or unrelated donor transplant should generally be limited to patients with a good performance status and early phase but otherwise incurable haematological disease.