Bone marrow transplantation using alternative donors. Mismatched related donors or closely matched unrelated donors.

PURPOSE

Bone marrow transplantation has been used with increasing frequency for the treatment of children with leukemia that is resistant to conventional therapy or in cases that have initial features indicating a poor prognosis.

PATIENTS AND METHODS

For those children who are in need of a transplant but who do not have a matched sibling as bone marrow donor, transplantation can be performed with marrow from either a closely matched unrelated donor or from a partially matched family member.

RESULTS

Comparable results have been reported for transplants using either one of these alternative types of donor marrow, but these results are not as good as those using HLA-matched siblings as donors.

CONCLUSIONS

Delays in engraftment, increased infection rates, and complications related to graft-versus-host disease makes transplants using marrow from alternative donors more difficult and less successful. Improved methods to control graft-versus-host disease and greater ability to prevent infections, particularly opportunistic viral infections, will increase the success rate for marrow transplants using alternative donors. In addition, expansion of the National Marrow Donor Registry increases the likelihood of finding unrelated donors for children requiring such transplants.