Unrelated donor bone marrow transplantation for thalassemia: The effect of extended haplotypes

Giorgio La Nasa, Claudio Giardini, Francesca Argiolu, Franco Locatelli, Marcella Arras, Piero De Stefano, Antonio Ledda, Antonella Pizzati, Maria A. Sanna, Adriana Vacca, Guido Lucarelli, Licinio Contu

Research output: Contribution to journalArticlepeer-review

Abstract

Allogeneic bone marrow transplantation (BMT) from a genotypically identical family donor is an accepted therapeutic option for homozygous beta-thalassemia. However, only a minority of patients have access to this curative procedure. The aim of this study is to explore the feasibility of matched unrelated transplants in thalassemia and the possibility of reducing the risk of immunologic complications through careful selection of donor/ recipient pairs. Since November 1992, 32 patients (age range, 2-28 years) have been enrolled. There were 4 patients assigned to risk-class I, 11 to risk-class II, and 17 to risk-class III of the Pesaro classification. Extended haplotype analysis and family segregation studies were employed for identification of suitable donors. Of the 32 donor/recipient pairs, 24 were identical for HLA-A, B, C, DRB1, DRB3, DRB4, DRB5, DQA1, and DQB1 loci; 7 pairs were identical for 2 extended haplotypes, and 15 pairs shared one extended haplotype. Grade II-IV acute graft-versus-host disease (GVHD) developed in 11 cases (41%) and chronic GVHD in 6 (25%) out of 24 patients at risk. There are 22 patients (69%) who are alive and transfusion-independent after a median follow-up of 30 months (range, 7-109 months). There were 6 patients (19%) who engrafted and subsequently died from transplant-related complications. In 4 cases (12.5%) graft rejection was observed within 30 days and it was followed by autologous reconstitution. Out of 22 patients with a donor identical for at least one extended haplotype, there are 19 who survived, 17 of them being transfusion-independent. Among the 10 recipients who did not share any extended haplotype with the donor, only 5 are alive without thalassemia and 3 patients died. Of the 6 patients who died, 5 belonged to risk-class III and only 1 to risk-class II. BMT from well-selected unrelated donors may offer results comparable to those obtained in transplantations using HLA-identical family donors, especially for patients with lesser iron overload.

Original languageEnglish
Pages (from-to)4350-4356
Number of pages7
JournalBlood
Volume99
Issue number12
DOIs
Publication statusPublished - Jun 15 2002

ASJC Scopus subject areas

  • Hematology

Fingerprint Dive into the research topics of 'Unrelated donor bone marrow transplantation for thalassemia: The effect of extended haplotypes'. Together they form a unique fingerprint.

Cite this