THE USE OF PARTIALLY MATCHED, UNRELATED DONORS IN CLINICAL BONE MARROW TRANSPLANTATION

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Abstract
It is estimated that 60-70% of patients who might benefit from a bone marrow transplant will not have a suitably matched, related donor. A clinical experiment was designed to test the safety and feasibility of using marrow from partially matched, unrelated donors. The transplant experience in the 1st 8 patients with leukemia undergoing this treatment is described. The 1st 4 patients had advanced leukemia at the time of transplantation. Each showed hematopoietic recovery, but all died from septic complications largely related to extended neutropenia encompassing both the pre-marrow-grafting and the post-marrow-grafting period. The next 4 patients were in remission at the time of transplantation. Each showed prompt and sustained hematopoiesis with variable graft-vs.-host disease (GVHD). No acute or chronic GVHD was seen in 2 patients, grade II (skin only) was seen in 1 patient, and grade IV (skin, liver and gut) was seen in new patient. One patient has died from sepsis 5.5 mo. following transplantation, and 3 are alive and well 6.5-9.5 postengraftment. Bone marrow transplantation with partially matched, unrelated marrow is a safe and feasible approach. If results are confirmed by longer follow-up in a larger group of patients, the development of marrow donor pools would appear justified.