FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Volume 328:593-602 March 4, 1993 Number 9 Next

Abstract Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background and Methods Allogeneic bone marrow transplantation is curative in a substantial number of patients with hematologic cancers, marrow-failure disorders, immunodeficiency syndromes, and certain metabolic diseases. Unfortunately, only 25 to 30 percent of potential recipients have HLA-identical siblings who can act as donors. In 1986 the National Marrow Donor Program was created in the United States to facilitate the finding and procurement of suitable marrow from unrelated donors for patients lacking related donors.

Results During the first four years of the program, 462 patients with acquired and congenital lymphohematopoietic disorders or metabolic diseases received marrow transplants from unrelated donors. The probability of engraftment by 100 days after transplantation was 94 percent, although 8 percent of patients later had secondary graft failure. The probability of grade II, III, or IV acute graft-versus-host disease was 64 percent, and the probability of chronic graft-versus-host disease at one year was 55 percent. The rate of disease-free survival at two years among patients with leukemia and good prognostic factors was 40 percent and among patients at higher risk, 19 percent. Twenty-nine percent of the patients with aplastic anemia were alive at two years, and the rate of two-year disease-free survival among patients with myelodysplasia was 18 percent. For patients with congenital immunologic or nonimmunologic disorders, the probability of survival was 52 percent.

Conclusions The National Marrow Donor Program has benefited a substantial number of patients in need of marrow transplants from closely HLA-matched unrelated donors and has facilitated the recruitment of unrelated donors into the donor pool and the access to suitable marrow.

Methods

The NMDP

The NMDP was established in 1986 through a contract from the U.S. Navy to the American Red Cross. Responsibility for the contract was transferred to the National Heart, Lung, and Blood Institute in February 1989. The procedure and policies of the NMDP have been described previously²⁹.

Patients

The study population consisted of 462 patients with malignant or nonmalignant diseases who received marrow transplants at centers in the United States between December 16, 1987, and November 3, 1990 (Table 1 and Table 2). Among the patients with leukemia, those projected to have a good outcome after transplantation included patients with acute leukemia in first or second complete remission and those with chronic myelogenous leukemia in the primary chronic phase. Patients with acute leukemia in more than second remission or in relapse and patients with chronic myelogenous leukemia in secondary or a more advanced chronic phase or in accelerated or blastic phase were considered to be at high risk. The infusion of marrow from an unrelated donor was the second transplantation procedure for six patients, and seven patients received two marrow transplants from unrelated NMDP donors.

View this table: [in this window] [in a new window]   Table 1. Characteristics of the 462 Patients, According to the Type of Disease That Led to Bone Marrow Transplantation.

 

View this table: [in this window] [in a new window]   Table 2. Characteristics of the Donors and Recipients.

 
Patients received a variety of preparative regimens determined by the individual transplantation centers and based on requirements for the treatment of the specific underlying disease. Of the 352 patients with leukemia, 306 (87 percent) received total-body irradiation and chemotherapy. Seventy percent of the patients with marrow-failure syndromes received total-body irradiation. Twenty-nine of the 41 patients with congenital disorders were treated with chemotherapy alone.

Methods for the prophylactic treatment of graft-versus-host disease (GVHD) varied according to the transplantation center. Ninety-five patients (21 percent) received marrow depleted of donor T cells: 70 of the 352 patients with leukemia (20 percent), 15 of the 63 patients with marrow-failure syndromes (24 percent), 9 of the 41 patients with a congenital disorder (22 percent), and 1 of the 6 patients with other malignant diseases (17 percent).

Donor Selection and Collection and Processing of Bone Marrow

The characteristics of the donors are shown in Table 2. The matching of donors and recipients was based on HLA serotyping performed according to standard techniques³⁰. A mismatch of one antigen was categorized as minor if the mismatched antigen was cross-reactive and as major if the antigen was not cross-reactive. Fifty-three donor centers provided at least 1 marrow donor, and three of these centers provided 50 or more donors. Forty-two collection facilities performed the marrow harvests; five centers harvested marrow from more than 25 donors each. The transported marrow was infused without manipulation in 215 patients (47 percent), whereas in 247 (53 percent) it was manipulated for the following reasons: volume reduction (13 patients, 3 percent), red-cell depletion for ABO incompatibility (139 patients, 30 percent), T-cell depletion for the prevention of GVHD (67 patients, 15 percent), or both ABO incompatibility and the prevention of GVHD (28 patients, 6 percent).

Data Collection

The transplantations were performed at 28 centers in the United States: 21 (75 percent) of the centers performed 1 to 9 transplantations, 1 center performed 12 procedures, 1 center 19 procedures, and 5 centers more than 25 primary transplantations (27, 36, 56, 83, and 129 procedures). The median length of follow-up was 1.5 years (range, 0.3 to 3.7). Data on survival were gathered until September 1, 1991, in all but two transplantation centers, in which the cutoff date was March 1, 1991. We considered that all patients were suitable for evaluation for engraftment, acute GVHD, and chronic GVHD. The day of engraftment was defined as the first of three consecutive days on which the neutrophil count exceeded 500 per cubic millimeter. Thus, patients in whom engraftment did not occur did not have a neutrophil count of more than 500 per cubic millimeter for three consecutive days at any time after transplantation. Patients with initial engraftment in whom severely hypocellular marrow or an absolute neutrophil count of less than 500 per cubic millimeter recurred were considered to have secondary graft failure. The stage of involvement of the skin, liver, and intestine with acute GVHD was measured individually according to standard criteria,³¹ and a grade was assigned on the basis of the sum of the individual stages: a grade of 0 was assigned for a score of 0; a grade of I for a score of 1 to 2; a grade of II for a score of 3 to 4, except in cases in which the skin, liver, or intestine alone was considered to be in stage 4, in which case a grade of III was assigned; and a grade of III to IV for a score of 5 or more. Chronic GVHD was assessed as limited (mild skin involvement only) or extensive (skin, liver, and intestinal involvement).

Statistical Analysis

Disease-free survival curves were calculated by Kaplan-Meier analysis³². The length of time from the first transplantation to an event was defined in three ways: as the interval between transplantation and relapse among patients who were reported to be free of their disease after transplantation, as the interval from transplantation to day 28 among patients who survived at least 28 days but were never free of their disease after transplantation, or as the interval between transplantation and death among patients who did not fit into the first two categories. In univariate analyses, the log-rank statistic³³ was determined, and its level of significance is given. All values reflect two-sided P values. The two-year disease-free survival rates and their 95 percent confidence intervals are given. In multivariate analyses involving the occurrence of disease-free survival and relapse among patients with leukemia, the proportional-hazards model³⁴ was used with the following covariates: recipient's age, recipient's cytomegalovirus status, the level of HLA matching (a disparity of 0 or 1 antigen), donor's age, donor's sex, the need to manipulate marrow to prevent GVHD, the interval between diagnosis and transplantation, the type of leukemia (chronic vs. acute), and leukemia status (good vs. poor prognostic factors). Only variables whose coefficients had P values of 0.10 are reported.

For nonfatal events, such as engraftment, the occurrence of grade II to IV or grade III to IV acute GVHD, or the occurrence of extensive chronic GVHD, death was defined as a censored variable in the life-table analyses. The censoring date for the analysis involving nonfatal events was the date of the last regular follow-up visit or the date of death. Both Kaplan-Meier and proportional-hazards models were employed. The following independent variables were considered for these dependent variables: recipient's age, recipient's cytomegalovirus status, the level of HLA matching, the use of T-cell-depleted marrow to prevent GVHD, and a diagnosis of chronic rather than acute myelogenous leukemia. An independent variable appearing in several proportional-hazards models was always coded in the same way, and only the variables whose coefficients had P values of 0.10 are reported. Results are given as the probability estimate ±1.96 times the standard error (i.e., the 95 percent confidence interval).

Results

Identification of Unrelated Donors

Among the 462 patients, 306 (66 percent) received marrow from a donor serologically matched for HLA-A, B, and DR antigens, whereas 61 (13 percent) received marrow with a minor mismatch of one HLA antigen and 92 (20 percent) received marrow with a major mismatch of one class I or class II HLA antigen. In three cases (1 percent) there was a mismatch of more than one HLA antigen. The median interval between the initiation of a preliminary search for a donor and marrow transplantation was 196 days (range, 17 to 1037). For patients with chronic myelogenous leukemia, the median interval was 252 days (range, 50 to 1037). For patients with other diagnoses, the median interval was 164 days (range, 17 to 709).

Engraftment

The probability of engraftment by 100 days after transplantation was 0.94 ±0.03 (95 percent confidence interval, 0.91 to 0.97); engraftment occurred a median of 22 days after transplantation (range, 6 to 84). On multivariate analysis, an accelerated rate of engraftment was independently associated with the receipt of marrow depleted of T cells (P<0.001), the receipt of HLA-matched marrow (P<0.001), and increasing patient age (P = 0.05).

Eight percent of the patients had graft failure between 25 and 263 days after transplantation. Among the variables examined, only the use of marrow depleted of T cells was significantly associated with secondary graft failure after initial engraftment (0.14 ±0.08 vs. 0.07 ±0.04, P = 0.04). One year after transplantation, 11 of 143 patients whose transfusion history could be evaluated continued to require transfusions of platelets (2 patients), red cells (2), or both (7).

GVHD

The probability of having grade II, III, or IV acute GVHD by 100 days after transplantation was 0.64 ±0.05 (95 percent confidence interval, 0.59 to 0.69), and a substantial number of the patients with GVHD had severe (grade III to IV) acute GVHD (0.47 ±0.06) (Figure 1A). Multivariate analysis showed that the development of grade III to IV acute GVHD was independently associated with the use of marrow that had not been depleted of T cells (P<0.001) (Figure 1B) and increasing patient age (P = 0.001) (Figure 1C). The development of acute GVHD was not associated with the level of HLA disparity, as defined by serologic analysis (Figure 1D).

View larger version (23K): [in this window] [in a new window]   Figure 1. Probability of Acute GVHD in All Patients (Panel A) and Probability of Grade III to IV Acute GVHD, According to Whether the Patients Received T-Cell-Depleted Marrow (Panel B), Their Age (Panel C), and Whether They Received HLA-Matched or HLA-Mismatched Marrow (Panel D). The P values reflect the results of univariate analysis.

 
The probability of limited or extensive chronic GVHD one year after transplantation was 0.55 ±0.07, whereas that of extensive chronic GVHD alone was 0.35 ±0.07 (Figure 2). Multivariate analysis showed that the development of extensive chronic GVHD was significantly associated with the use of marrow that had not been depleted of T cells (P = 0.001) and with a diagnosis of chronic myelogenous leukemia (P<0.001). Univariate analysis indicated that extensive chronic GVHD correlated with increasing patient age; however, no such correlation was found on multivariate analysis, since the patients with chronic myelogenous leukemia were older (Table 1) and the diagnosis of chronic myelogenous leukemia was found to be the significant independent variable, rather than patient age.

View larger version (17K): [in this window] [in a new window]   Figure 2. Probability of Limited or Extensive Chronic GVHD and of Extensive Chronic GVHD Alone in All Patients.

 
Survival

            Patients with Leukemia

The patients with leukemia were followed for a median of 1.5 years (range, 0.72 to 3.7). The probability of disease-free survival at two years among patients with leukemia and good prognostic factors was 0.40 ±0.08, whereas it was 0.19 ±0.06 (P<0.001) among patients with leukemia and poor prognostic factors. Among patients with acute leukemia in first or second remission, the probability of disease-free survival was 0.45 ±0.13, which was superior to that among patients with more advanced disease (0.19 ±0.08, P<0.001). Similarly, among patients with chronic myelogenous leukemia in the primary chronic phase, the disease-free survival at two years was 0.37 ±0.10, which was higher than that among patients with more advanced disease (0.21 ±0.09, P = 0.02). Although these results suggest that patients with acute leukemia had a more favorable probability of disease-free survival than patients with chronic leukemia, multivariate analysis in which recipient's age was included as a variable indicated the reverse (P = 0.02). Several variables were examined by multivariate analysis for their effect on the survival of patients with leukemia. Those found to be significant are presented in Table 3. Seventy of the 352 patients with leukemia received marrow depleted of T cells. There was a trend (P = 0.10) toward improved disease-free survival among these patients. Considering the results of multivariate analysis, it is not surprising that patients under the age of 18 years who had good prognostic factors for leukemia did well after transplantation. Among 41 such patients, the probability of disease-free survival at two years was 0.53 ±0.15. In contrast, the probability of disease-free survival among patients over the age of 18 who had poor prognostic factors for leukemia was 0.11 ±0.06 (Figure 3).

View this table: [in this window] [in a new window]   Table 3. Factors Significantly Associated with Leukemia-free Survival after Marrow Transplantation from an Unrelated Donor.

 

View larger version (23K): [in this window] [in a new window]   Figure 3. Probability of Disease-free Survival, According to Prognostic Factors for Leukemia and Age.

 
The probability of relapse within two years after transplantation among all patients with leukemia was 0.19 ±0.06. The patients over 18 years of age who had acute leukemia were at greatest risk for relapse (Figure 4). The risk variables, as determined by multivariate analysis, that were associated with relapse included older age (P = 0.001), acute leukemia as opposed to chronic leukemia (P = 0.03), HLA mismatch (P<0.001), positive cytomegalovirus-antibody status among recipients (P = 0.04), and the use of marrow that had not been depleted of T cells (P = 0.009). The use of marrow depleted of T cells appeared primarily to delay relapse rather than to reduce the relapse rate.

View larger version (20K): [in this window] [in a new window]   Figure 4. Probability of Relapse after Transplantation, According to Type of Leukemia and Age.

 
            Patients with Myelodysplasia or Aplastic Anemia

The median interval from diagnosis to transplantation was 0.9 year (range, 0.2 to 8.2) among patients with aplastic anemia and 0.9 year (range, 0.3 to 10.3) among patients with myelodysplasia. The probability of survival at two years was 0.29 ±0.17 among patients with aplastic anemia or paroxysmal nocturnal hemoglobinuria (Figure 5). However, 4 of the 10 patients with aplasia who were alive one year after transplantation continued to require transfusions of platelets (2 patients), red cells (1), or both (1). Although the probability of survival among patients with myelodysplasia was 0.24 ±0.15, not all patients were disease-free. The probability of disease-free survival at two years was 0.18 ±0.14 (Figure 5).

View larger version (15K): [in this window] [in a new window]   Figure 5. Probability of Survival among Patients with Aplastic Anemia or Paroxysmal Nocturnal Hemoglobinuria and Patients with Myelodysplasia.

 
            Patients with Congenital Disorders

Forty-one patients received a transplant for the treatment of a congenital disorder reported to be amenable to therapy with marrow from an HLA-identical sibling³⁵. The immunodeficiency disorders included combined immunodeficiency syndromes (9 patients), Wiskott-Aldrich syndrome (5), T-cell deficiency (2), common variable immunodeficiency (2), ataxia-telangiectasia (2), and leukocyte-adhesion deficiency (1). Among the patients treated for non-immunodeficiency congenital disorders, the majority had Hurler's syndrome (10). Other diagnoses included Sanfilippo's syndrome (2 patients), globoid leukodystrophy (2), Fanconi's anemia (1), osteopetrosis (1), Hunter's syndrome (1), Gaucher's disease (1), and familial erythrophagocytic lymphohistiocytosis (2). In this group of patients, the probability of engraftment within 100 days after transplantation was 0.96 ±0.07, whereas the probability of having grade II, III, or IV acute GVHD within 100 days was 0.37 ±0.17. The probability of having extensive chronic GVHD at one year was 0.08 ±0.11. Because of the nature of these diseases, it is not currently possible to address whether these patients were disease-free after transplantation. However, the probability of survival among patients with congenital immunodeficiency, hematologic, or metabolic disorders two years after transplantation was 0.52 ±0.17

            Patients with Other Malignant Conditions

One of the four patients with non-Hodgkin's lymphoma survived (>604 days at the time survival data were censored). This patient was only 2.6 years of age at the time of transplantation and did not have severe acute or chronic GVHD, whereas the other patients were all over the age of 35 years and either died soon after transplantation (day 3) or had severe (grade III) acute GVHD and died within 120 days after transplantation. The patient with multiple myeloma, who was 37.5 years of age at transplantation, survived (>589 days at the time survival data were censored), and the patient with Hodgkin's disease, who was 28.8 years old at transplantation, died of grade III acute GVHD 114 days after transplantation.

            Patients Who Received Second Transplants

Five of the six patients whose NMDP-facilitated transplant was their second transplant had received an autologous transplant for the treatment of acute leukemia or lymphoma (acute lymphoblastic leukemia in one, non-Hodgkin's lymphoma in one, and acute nonlymphocytic leukemia in three). One of these five patients was alive more than 400 days after transplantation, and another 1150 days after transplantation. The sixth patient had received a transplant for the treatment of aplastic anemia 1 month earlier from an unrelated donor identified through the Anthony Nolan Registry in England, and he died 70 days after receiving his second transplant.

Seven patients received a second marrow graft from an unrelated donor identified through the NMDP because of primary failure of the marrow to engraft or secondary graft failure after their first transplantation. The same donor was used for only one of these patients. Three had received marrow that had not been depleted of T cells, and four received marrow that had been depleted of T cells. The median interval between the first and second transplantations was 64 days (range, 55 to 464). One of the seven patients survived. This patient (who had chronic myelogenous leukemia in chronic phase) received an infusion of cryopreserved autologous marrow when his second marrow infusion from an unrelated donor failed to engraft.

Complications and Causes of Death

One hundred thirty-eight patients (30 percent) had interstitial pneumonia, 109 (24 percent) were reported to have had hepatic dysfunction consistent with venoocclusive disease, 35 (8 percent) to have had cardiac failure, and 8 (2 percent) to have had a B-cell lymphoproliferative disorder. Lymphoproliferative disorders were observed among patients who received marrow depleted of T cells (5 patients [5 percent]) as well as those who did not (3 patients [1 percent]). Furthermore, lymphoproliferative disorders were observed among patients who did not have acute GVHD (3 of 213 patients) as well as among those who did (5 of 249 patients).

Of the 462 patients, 307 (66 percent) have died. The primary and secondary causes of death are listed in Table 4.

View this table: [in this window] [in a new window]   Table 4. Primary and Secondary Causes of Death after Transplantation in 307 Patients.

 
The latest Karnofsky score was evaluated in 145 patients who survived at least one year. Ninety-nine (68 percent) had a performance score of 90 or 100, whereas 11 (8 percent) had a score of 80, 14 (10 percent) had a score between 20 and 70, and 21 (14 percent) had died after one year. Neither the age of the recipients nor the degree of HLA matching influenced these scores.

Discussion

Transplantation of bone marrow from an HLA-identical sibling results in prolonged leukemia-free survival in approximately 50 percent of patients with good prognostic factors and in up to 20 percent of patients with advanced leukemia^1,2,36,37. The survival rate among patients with aplastic anemia is 50 to 80 percent for patients receiving HLA-identical grafts,³⁸ and disease-free survival among patients with myelodysplasia ranges from 30 to 50 percent³⁹. Several studies of marrow transplantation with related donors other than genotypically HLA-identical siblings indicate that the probability of having serious complications after transplantation, including graft failure, acute and chronic GVHD, fatal infections, and lymphoproliferative disorders, is increased as compared with that observed after the transplantation of marrow from an HLA-identical sibling and is higher among recipients of grafts that are not matched for two or three HLA loci than among recipients of marrow with a single HLA disparity^{17,40,41,42,43,44,45,46,47,48,49}. Similarly, reports from individual centers that involve 8 to 55 recipients who received marrow from closely HLA-matched unrelated donors indicate that both the incidence and the severity of complications may be increased in these patients^{12,13,15,17,18,19,20,21,22}.

The probability of graft failure after an infusion of marrow from a family member correlates with the degree of HLA incompatibility^41,45,50 and the use of T-cell depletion to prevent acute and chronic GVHD^21,50,51,52. In the present NMDP study of 462 patients, graft failure was evaluated by calculating the probability of both initial myeloid engraftment and secondary marrow failure. The probability of engraftment for the entire study population was lower than that reported by Beatty et al.²² but similar to that reported by Ash et al.,²¹ who used in vitro T-cell depletion to prevent GVHD. In our study the probability of engraftment within 100 days after transplantation was 0.94 ±0.03, with an accelerated rate of engraftment independently associated with the receipt of marrow depleted of T cells and with the receipt of HLA-matched marrow. The difference in the length of time to engraftment between marrow depleted of T cells and unmanipulated marrow may be due to factors other than the use of T-cell-depleted marrow, such as the use of post-transplantation chemoprophylaxis regimens that include intravenous methotrexate, which would be expected to delay engraftment. Transplantation centers that used in vitro T-cell depletion to prevent GVHD did not use methotrexate, but rather used corticosteroids, cyclosporine, and antithymocyte globulin. In contrast, most centers that infused unmodified marrow used methotrexate to prevent GVHD after transplantation.

The probability of severe acute GVHD was higher in our patients than in recipients of marrow from HLA-matched siblings; the probability of having grade II, III, or IV acute GVHD was 0.64 ±0.05. This high probability is comparable to that observed among recipients of unmanipulated marrow mismatched for one or two HLA antigens from a family member^22,41. Yet in our series the level of donor-recipient HLA disparity, as evaluated by serotyping, did not affect the probability of the development of acute GVHD. This probably reflects the fact that phenotypically HLA-identical unrelated pairs of donors and recipients have important differences in structural polymorphisms that are not detectable by conventional serotyping for HLA-A, B, and DR alloantigens. These differences can be detected in the HLA class I region by one-dimensional isoelectric focusing^53,54,55 and in the class II region by restriction-fragment-length polymorphism^56,57 and hybridization with sequence-specific oligonucleotide probes^56,58,59,60. In the present study, in which 272 donor-recipient pairs had interpretable results of mixed-lymphocyte culture, there was no correlation between the level of reactivity and the incidence or severity of acute GVHD (data not shown).

Despite the increased risk of graft failure and severe acute and chronic GVHD, this study demonstrates in a large patient population that the transplantation of marrow from unrelated donors can be an effective treatment for certain hematologic cancers and non-neoplastic disorders. Among 352 patients with leukemia, the probability of disease-free survival at two years was 0.40 ±0.08 for patients with good prognostic factors and 0.19 ±0.06 for patients with poor prognostic factors. Post-transplantation relapse is a serious problem for recipients of marrow from HLA-identical siblings, with patients who undergo transplantation while in relapse at the highest risk⁶¹. In our study, the stage of disease was not associated with the risk of relapse, but it was associated with the risk of death.

Although recipients of HLA-identical marrow depleted of T cells for the treatment of advanced leukemia or chronic myelogenous leukemia are at increased risk of relapse after transplantation,^62,63 recipients of T-cell-depleted marrow from unrelated donors do not appear to be at a similar increased risk for relapse. The low probability of relapse in the NMDP patient population is encouraging and suggests that transplants from unrelated donors may offer a considerable graft-versus-leukemia effect. However, the effect of other factors reported to influence the probability of post-transplantation relapse, including the pretransplantation preparative regimen, the presence of GVHD, and post-transplantation immunosuppression,^61,64,65,66 has not been examined, and a longer follow-up is necessary for a definitive analysis of relapse in this patient population.

Seventy of the 352 patients with leukemia received marrow depleted of T cells for the prevention of acute and chronic GVHD. The use of T-cell-depleted marrow was associated with more rapid engraftment, a decrease in the incidence and severity of GVHD, and a reduction in the mortality rate by approximately 60 percent during the first 50 days after transplantation. Thereafter, there was no difference in survival among patients with leukemia who received T-cell-depleted marrow and those who received unmanipulated marrow. Since this initial analysis does not reveal an increase in relapse among recipients of T-cell-depleted marrow, it is unclear why the leukemia-free survival rate was only marginally improved for these patients as determined by multivariate analysis (P = 0.10). The effects of T-cell depletion in our study should be interpreted cautiously, however, since only 5 of the 28 transplantation centers used this approach to prevent GVHD, and T-cell depletion may be a marker for the effects of the complete regimen or any one of the components of the regimen used for the marrow procedure. Nevertheless, the finding is similar to that observed in a retrospective review that analyzed the effect of T-cell depletion on the outcome of marrow transplantation from related donors other than HLA-identical siblings⁵⁰.

For young adults who have an HLA-matched family member, bone marrow transplantation is the preferred treatment for severe aplastic anemia^38,67,68. HLA-incompatible family members or closely matched unrelated persons have donated marrow to patients lacking an HLA-identical sibling^16,17,20,69. In the present study, patients with aplastic anemia generally had poor prognostic characteristics⁷⁰. All patients had received multiple blood transfusions, and there was a relatively long interval between diagnosis and transplantation. However, the probability of survival after this procedure in this group of patients (0.29 ±0.17) is probably superior to that with other available therapies, since in qualifying for transplantation protocols involving unrelated donors, it is likely that these patients had not responded to immunosuppressive or cytokine therapy.

Approximately 50 to 60 percent of patients with myelodysplasia who are under the age of 30 years are disease-free three years after the transplantation of marrow from HLA-matched siblings, whereas the probability of disease-free survival is only 25 percent among patients over the age of 30^39,71,72,73. When compared with the results of the transplantation of marrow from HLA-identical siblings, the results of the 32 procedures involving marrow from unrelated donors in the present study are disappointing; the probability of disease-free survival at two years was 0.18 ±0.14. The median age of these patients was 24.3 years, and the distribution of patients within the diagnostic subgroups was not skewed toward advanced disease; only 11 of the 32 patients had excess blasts. Thus, neither older age nor advanced disease accounted for the poor outcome.

Recipients of partially matched transplants from family members are at higher risk for infectious complications and lymphoproliferative disorders than are recipients of transplants from HLA-identical siblings^46,48. This observation has been extended to recipients of marrow from unrelated donors^15,21 and is true of the present study, in which infection, interstitial pneumonia, or both contributed to 58 percent of the deaths and in which secondary lymphoproliferative disorders developed in eight patients.

Although the optimal approaches to the selection of an unrelated donor and the prevention of graft failure and acute and chronic GVHD remain to be defined, this report demonstrates that transplantation with marrow derived from an unrelated donor can benefit many patients.

We are indebted to Ms. Patricia Coppo and her staff of donor-search coordinators at the NMDP, to Ms. Jessie Song and Ms. Qin Tian for computer-programming support, and to Ms. Carolynn Barnes for assistance with the preparation of the manuscript.

Source Information

From the Memorial Sloan-Kettering Cancer Center, New York (N.A.K.); University of Minnesota, Minneapolis (G.B., A.F., J.M., P.M., D.S.); Fred Hutchinson Cancer Center, Seattle (J.A.H., J.S., E.D.T.); Medical College of Wisconsin, Milwaukee (R.C.A.); University of Utah School of Medicine, Salt Lake City (P.G.B.); University of Texas, Houston (R.C.); University of California, Los Angeles (J.G.); University of Kentucky, Lexington (J.H.-D.); Irwin Memorial Blood Center, San Francisco (H.A.P.); Vancouver General Hospital, Vancouver, B.C., Canada (G.L.P.); and Stanford University Medical Center, Stanford, Calif. (K.G.B.). The centers participating in this study from the National Marrow Donor Program are listed in the Appendix.

Address reprint requests to Dr. Kernan at Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.

References

1. Thomas ED. Karnofsky memorial lecture: marrow transplantation for malignant diseases. J Clin Oncol 1983;1:517-531. [Free Full Text]
2. O'Reilly RJ. Allogeneic bone marrow transplantation: current status and future directions. Blood 1983;62:941-964. [Free Full Text]
3. Bortin MM, Rimm AA. Increasing utilization of bone marrow transplantation: II. Results of the 1985-1987 survey. Transplantation 1989;48:453-458. [Medline]
4. Horowitz SD, Groshong T, Bach FH, Hong R. Treatment of severe combined immunodeficiency with bone-marrow from an unrelated, mixed-leucocyte-culture-nonreactive donor. Lancet 1975;2:431-433. [Medline]
5. O'Reilly RJ, Dupont B, Pahwa S, et al. Reconstitution in severe combined immunodeficiency by transplantation of marrow from an unrelated donor. N Engl J Med 1977;297:1311-1318. [Abstract]
6. The Westminster Hospitals Bone-Marrow Transplant Team. Bone-marrow transplant from an unrelated donor for chronic granulomatous disease. Lancet 1977;1:210-213. [CrossRef][Medline]
7. Speck B, Zwaan FE, van Rood JJ, Eernisse JG. Allogeneic bone marrow transplantation in a patient with aplastic anemia using a phenotypically HL-A-identical unrelated donor. Transplantation 1973;16:24-28. [CrossRef][Medline]
8. Lohrmann H-P, Dietrich M, Goldmann SF, et al. Bone marrow transplantation for aplastic anaemia from a HL-A and MLC-identical unrelated donor. Blut 1975;31:347-354. [CrossRef][Medline]
9. Hansen JA, Clift RA, Thomas ED, Buckner CD, Storb R, Giblett ER. Transplantation of marrow from an unrelated donor to a patient with acute leukemia. N Engl J Med 1980;303:565-567. [Medline]
10. Gordon-Smith EC, Fairhead SM, Chipping PM, et al. Bone-marrow transplantation for severe aplastic anaemia using histocompatible unrelated volunteer donors. BMJ 1982;285:835-837.
11. Duquesnoy RJ, Zeevi A, Marrari M, Hackbarth S, Camitta B. Bone marrow transplantation for severe aplastic anemia using a phenotypically HLA-identical, SB-compatible unrelated donor. Transplantation 1983;35:566-571. [Medline]
12. Hows JM, Yin JL, Marsh J, et al. Histocompatible unrelated volunteer donors compared with HLA nonidentical family donors in marrow transplantation for aplastic anemia and leukemia. Blood 1986;68:1322-1328. [Free Full Text]
13. Howard MR, Hows JM, Gore SM, et al. Unrelated donor marrow transplantation between 1977 and 1987 at four centers in the United Kingdom. Transplantation 1990;49:547-553. [Medline]
14. McGlave P, Scott E, Ramsay N, et al. Unrelated donor bone marrow transplantation therapy for chronic myelogenous leukemia. Blood 1987;70:877-881. [Free Full Text]
15. Gingrich RD, Ginder GD, Goeken NE, et al. Allogeneic marrow grafting with partially mismatched, unrelated marrow donors. Blood 1988;71:1375-1381. [Free Full Text]
16. Bacigalupo A, Hows J, Gordon-Smith EC, et al. Bone marrow transplantation for severe aplastic anemia from donors other than HLA identical siblings: a report of the BMT Working Party. Bone Marrow Transplant 1988;3:531-535. [Medline]
17. Camitta B, Ash R, Menitove J, et al. Bone marrow transplantation for children with severe aplastic anemia: use of donors other than HLA-identical siblings. Blood 1989;74:1852-1857. [Free Full Text]
18. McGlave PB, Beatty P, Ash R, Hows JM. Therapy for chronic myelogenous leukemia with unrelated donor bone marrow transplantation: results in 102 cases. Blood 1990;75:1728-1732. [Erratum, Blood 1990;76:654.] [Free Full Text]
19. Mackinnon S, Hows JM, Goldman JM, et al. Bone marrow transplantation for chronic myeloid leukemia: the use of histocompatible unrelated volunteer donors. Exp Hematol 1990;18:421-425. [Medline]
20. Gajewski JL, Ho WG, Feig SA, Hunt L, Kaufman N, Champlin RE. Bone marrow transplantation using unrelated donors for patients with advanced leukemia or bone marrow failure. Transplantation 1990;50:244-249. [Medline]
21. Ash RC, Casper JT, Chitambar CR, et al. Successful allogeneic transplantation of T-cell-depleted bone marrow from closely HLA-matched unrelated donors. N Engl J Med 1990;322:485-494. [Abstract]
22. Beatty PG, Hansen JA, Longton GM, et al. Marrow transplantation from HLA-matched unrelated donors for treatment of hematologic malignancies. Transplantation 1991;51:443-447. [Medline]
23. McCullough J. Bone marrow transplantation from unrelated volunteer donors: summary of a conference on scientific, ethical, legal, financial, and other practical issues. Transfusion 1982;22:78-81. [Medline]
24. McCullough J, Rogers G, Dahl R, et al. Development and operation of a program to obtain volunteer bone marrow donors unrelated to the patient. Transfusion 1986;25:315-323. [CrossRef]
25. McElligott MC, Menitove JE, Aster RH. Recruitment of unrelated persons as bone marrow donors: a preliminary experience. Transfusion 1986;26:309-314. [Medline]
26. Bradley B, Bidwell JL, Jarrold EA, Goffin RB, Klouda PT. HLA matched unrelated bone marrow transplants: a proposal to speed up donor selection using a DNA bank. Bone Marrow Transplant 1986;1:146-147. 
27. Raffoux C, Gluckman E, Busson M, Prevost P. Development of a national volunteer donor's file for bone marrow transplantation. Bone Marrow Transplant 1988;3:Suppl I:163-164.
28. Beatty PG, Dahlberg S, Mickelson EM, et al. Probability of finding HLA-matched unrelated marrow donors. Transplantation 1988;45:714-718. [Medline]
29. McCullough J, Hansen J, Perkins H, Stroncek D, Bartsch G. Establishment of the National Bone Marrow Donor Registry. In: Gale RP, Champlin RE, eds. Bone marrow transplantation: current controversies. Vol. 91 of UCLA Symposia on Molecular and Cellular Biology, new series. New York: Alan R. Liss, 1989:641-58.
30. Hopkins KA. Basic microlymphocytotoxicity test. In: Zachary AA, Teresi GA, eds. Laboratory manual. 2nd ed. Lenexa, Kans.: American Society for Histocompatibility and Immunogenetics, 1990:195-201.
31. Glucksberg H, Storb R, Fefer A, et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation 1974;18:295-304. [Medline]
32. Kaplan EL, Meier P. Nonparametic estimation from incomplete observations. J Am Stat Assoc 1958;53:457-81.
33. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 1966;50:163-170. [Medline]
34. Cox DR. Regression models and life-tables. J R Stat Soc [B] 1972;34:187-220.
35. O'Reilly RJ, Brochstein J, Dinsmore R, Kirkpatrick D. Marrow transplantation for congenital disorders. Semin Hematol 1984;21:188-221. [Medline]
36. Brochstein JA, Kernan NA, Groshen S, et al. Allogeneic bone marrow transplantation after hyperfractionated total-body irradiation and cyclophosphamide in children with acute leukemia. N Engl J Med 1989;317:1618-1624. [Abstract]
37. Santos GW, Kaizer H. Bone marrow transplantation in acute leukemia. Semin Hematol 1982;19:227-239. [Medline]
38. Storb R, Thomas ED, Buckner CD, et al. Marrow transplantation for aplastic anemia. Semin Hematol 1984;21:27-35. [Medline]
39. Appelbaum FR, Barrall J, Storb R, et al. Bone marrow transplantation for patients with myelodysplasia: pretreatment variables and outcome. Ann Intern Med 1990;112:590-597.
40. Powles RL, Morgenstern GR, Kay HEM, et al. Mismatched family donors for bone-marrow transplantation as treatment for acute leukemia. Lancet 1983;1:612-615. [CrossRef][Medline]
41. Beatty PG, Clift RA, Mickelson EM, et al. Marrow transplantation from related donors other than HLA-identical siblings. N Engl J Med 1985;313:765-771. [Abstract]
42. Bozdech MJ, Sondel PM, Trigg ME, et al. Transplantation of HLA-haploidentical T-cell-depleted marrow for leukemia: addition of cytosine arabinoside to the pretransplant conditioning prevents rejection. Exp Hematol 1985;13:1201-1210. [Medline]
43. Cahn JY, Herve P, Flesch M, et al. Marrow transplantation from HLA non-identical family donors for the treatment of leukaemia: a pilot study of 15 patients using additional immunosuppression and T-cell depletion. Br J Haematol 1988;69:345-349. [Medline]
44. Kernan NA, Flomenberg N, Dupont B, O'Reilly RJ. Graft rejection in recipients of T-cell-depleted HLA-nonidentical marrow transplants for leukemia: identification of host-derived antidonor allocytotoxic T lymphocytes. Transplantation 1987;43:842-847. [Medline]
45. Anasetti C, Amos D, Beatty PG, et al. Effect of HLA compatibility on engraftment of bone marrow transplants in patients with leukemia or lymphoma. N Engl J Med 1989;320:197-204. [Abstract]
46. Shapiro RS. Epstein-Barr virus-associated B-cell lymphoproliferative disorders in immunodeficiency: meeting the challenge. J Clin Oncol 1990;8:371-373. [Medline]
47. Sondel PM, Hank JA, Trigg ME, et al. Transplantation of HLA-haploidentical T-cell-depleted marrow for leukemia: autologous marrow recovery with specific immune sensitization to donor antigens. Exp Hematol 1986;14:278-286. [Medline]
48. Atkinson K, Farewell V, Storb R, et al. Analysis of late infections after human bone marrow transplantation: role of genotypic nonidentity between marrow donor and recipient and of nonspecific suppressor cells in patients with chronic graft-versus-host disease. Blood 1982;60:714-720. [Free Full Text]
49. Bunin NJ, Casper JT, Chitambar C, et al. Partially matched bone marrow transplantation in patients with myelodysplastic syndromes. J Clin Oncol 1988;6:1851-1855. [Abstract]
50. Ash RC, Horowitz MM, Gale RP, et al. Bone marrow transplantation from related donors other than HLA-identical siblings: effect of T cell depletion. Bone Marrow Transplant 1991;7:443-452. [Medline]
51. O'Reilly RJ, Collins NH, Kernan NA, et al. Transplantation of marrow-depleted T cells by soybean lectin agglutination and E-rosette depletion: major histocompatibility complex-related graft resistance in leukemic transplant recipients. Transplant Proc 1985;17:455-459. 
52. Trigg ME, Billing R, Sondel PM, et al. Clinical trial depleting T lymphocytes from donor marrow for matched and mismatched allogeneic bone marrow transplants. Cancer Treat Rep 1985;69:377-386. [Medline]
53. Choo SY, Antonelli P, Nisperos B, Nepom GT, Hansen JA. Six variants of HLA-B27 identified by isoelectric focusing. Immunogenetics 1986;23:24-29. [Medline]
54. Vasilov RG, Hahn A, Molders H, van Rood JJ, Breuning M, Ploegh HL. Analysis of human class I antigens by two-dimensional gel electrophoresis. Immunogenetics 1983;17:333-356. [Medline]
55. Neefjes JJ, Breur-Vriesendorp BS, van Seventer GA, Ivanyi P, Ploegh HL. An improved biochemical method for the analysis of HLA-class I antigens: definition of new HLA-class I subtypes. Hum Immunol 1986;16:169-181. [CrossRef][Medline]
56. Clay TM, Bidwell JL, Howard MR, Bradley BA. PCR-fingerprinting for selection of HLA matched unrelated marrow donors. Lancet 1991;337:1049-1052. [CrossRef][Medline]
57. Noreen HJ, Davidson ML, McCullough J, Bach FH, Segall M. HLA class II typing by restriction fragment length polymorphism (RFLP) in unrelated bone marrow transplant patients. Transplant Proc 1989;21:2968-2970. [Medline]
58. Baxter-Lowe LA, Eckels DD, Ash R, Casper J, Hunter JB, Gorski J. Future directions in selection of donors for bone marrow transplantation: role of oligonucleotide genotyping. Transplant Proc 1991;23:1699-1700. [Medline]
59. Angelini G, de Preval C, Gorski J, Mach B. High-resolution analysis of the human HLA-DR polymorphism by hybridization with sequence-specific oligonucleotide probes. Proc Natl Acad Sci U S A 1986;83:4489-4493. [Erratum, Proc Natl Acad Sci U S A 1986;83:6664.] [Free Full Text]
60. Tiercy JM, Morel C, Freidel AC, et al. Selection of unrelated donors for bone marrow transplantation is improved by HLA class II genotyping with oligonucleotide hybridization. Proc Natl Acad Sci U S A 1991;88:7121-7125. [Free Full Text]
61. Buckner CD, Clift RA, Appelbaum FR, et al. Effects of treatment regimens on post marrow transplant relapse. Semin Hematol 1991;28:32-34. [Medline]
62. McGlave P. Bone marrow transplants in chronic myelogenous leukemia: an overview of determinants of survival. Semin Hematol 1990;27:23-30. [Medline]
63. Goldman JM, Gale RP, Horowitz MM, et al. Bone marrow transplantation for chronic myelogenous leukemia in chronic phase: increased risk for relapse associated with T-cell depletion. Ann Intern Med 1988;108:806-814.
64. Clift RA, Buckner CD, Appelbaum FR, et al. Allogeneic marrow transplantation in patients with chronic myeloid leukemia in the chronic phase: a randomized trial of two irradiation regimens. Blood 1991;77:1660-1665. [Free Full Text]
65. Weiden PL, Sullivan KM, Flournoy N, Storb R, Thomas ED, Seattle Marrow Transplant Team. Antileukemic effect of chronic graft-versus-host disease: contribution to improved survival after allogeneic marrow transplantation. N Engl J Med 1981;304:1529-1533. [Medline]
66. Sullivan KM, Weiden PL, Storb R, et al. Influence of acute and chronic graft-versus-host disease on relapse and survival after bone marrow transplantation from HLA-identical siblings as treatment of acute and chronic leukemia. Blood 1989;73:1720-1728. [Erratum, Blood 1989;74:1180.] [Free Full Text]
67. Sanders JE, Whitehead J, Storb R, et al. Bone marrow transplantation experience for children with aplastic anemia. Pediatrics 1986;77:179-186. [Free Full Text]
68. Casper JT, Truitt RR, Baxter-Lowe LA, Ash RC. Bone marrow transplantation for severe aplastic anemia in children. Am J Pediatr Hematol Oncol 1990;12:434-448. [Medline]
69. Gordon BG, Strandjord SE, Warkentin PI, Kadushin J, Coccia PF. Successful treatment of severe aplastic anemia by bone marrow transplantation from HLA nonidentical family members: preliminary results utilizing cyclophosphamide and 600 cGY fractionated total body irradiation. Am J Pediatr Hematol Oncol 1991;13:29-33. [Medline]
70. Champlin RE, Horowitz MM, van Bekkum DW, et al. Graft failure following bone marrow transplantation for severe aplastic anemia: risk factors and treatment results. Blood 1989;73:606-613. [Free Full Text]
71. Longmore G, Guinan EC, Weinstein HJ, Gelber RD, Rappeport JM, Antin JH. Bone marrow transplantation for myelodysplasia and secondary acute nonlymphoblastic leukemia. J Clin Oncol 1990;8:1707-1714. [Abstract]
72. De Witte T, Zwaan F, Gratwohl A, et al. Timing of marrow transplantation in secondary leukemias and myelodysplastic syndromes. Transplant Proc 1989;21:2958-2959. [Medline]
73. Guinan EC, Tarbell NJ, Tantravahi R, Weinstein HJ. Bone marrow transplantation for children with myelodysplastic syndromes. Blood 1989;73:619-622. [Free Full Text]

The following centers participated in the National Marrow Donor Program: Transplantation centers: Fred Hutchinson Cancer Research Center; University of Minnesota Hospital and Clinic; UCLA; Medical College of Wisconsin; Memorial Sloan-Kettering Cancer Center; University of Kentucky Medical Center; J. Hillis Miller Center-Gainesville; Indiana University Hospital-Indiana University Medical Center; University of Nebraska Medical Center; Seattle Veterans Affairs Medical Center; City of Hope National Medical Center; University of Iowa Hospitals and Clinics; Cleveland Clinic Foundation; Ohio State University Hospital; Hahnemann University Hospital; Georgetown University Hospital-Lombardi Cancer Research Center; Stanford University Medical Center; Montefiore University Hospital-University of Pittsburgh; Children's-Brigham and Women's Hospital Transplant Unit; Children's Hospital of Los Angeles; Wayne State University-Harper Hospitals; Vanderbilt University Medical Center; Children's Hospital Medical Center, Cincinnati; All Children's Hospital, St. Petersburg; Children's Hospital of Philadelphia; University of California, San Francisco, Pediatric Bone Marrow Transplantation Program; Johns Hopkins Oncology Center; and University of Southern Florida; Donor centers: Blood Center of Southeastern Wisconsin; American Red Cross, St. Paul Region; Puget Sound Blood Center; Sacramento Medical Foundation Blood Center; Heart of America Bone Marrow Donor Registry; National Institutes of Health Marrow Donor Center; American Red Cross Central California Region, San Jose; American Red Cross, Greater Upstate New York Region, Albany Site; Central Indiana Regional Blood Center; American Red Cross Los Angeles-Orange Counties Region; Europdonor Foundation; American Red Cross, Carolinas Region; American Red Cross, Penn-Jersey Region; American Red Cross, Pacific Northwest Region; American Red Cross, Great Lakes Region; American Red Cross, Northwest Ohio Region; San Diego Blood Bank; Blood Center at Wadley Institutes; Greater New York Blood Program; Community Blood Bank; American Red Cross, Detroit; American Red Cross, Rochester; American Red Cross, Burlington; American Red Cross, Madison; American Red Cross, Baltimore; Civitan Regional Blood Center; Florida Reference Labs; American Red Cross, Dedham; American Red Cross, Fort Wayne; American Red Cross, Columbus; Johns Hopkins Hemapheresis Center; Irwin Memorial Blood Bank; Stanford University Blood Center; Blood Bank, San Bernardino-Riverside; American Red Cross, Farmington; American Red Cross, Atlanta; American Red Cross, Wichita; American Red Cross, Syracuse; Central Blood Bank; American Red Cross, Columbia; Hoxworth Blood Center; American Red Cross, Cleveland; American Red Cross, Peoria; Dana-Farber Cancer Institute; American Red Cross, Omaha; Spokane and Inland Empire Blood Bank; South Florida Regional Blood Service; Oklahoma Blood Institute; American Red Cross, Johnstown; American Red Cross, Washington; Michigan Community Blood Center; Belle Bonfils Memorial Blood Center; and New Jersey HLA Registry Foundation; Collection centers: University of Minnesota Hospital and Clinic; Virginia Mason Clinic; Milwaukee County Medical Complex; Mercy General Hospital; Medical College of Wisconsin; Genesee Hospital; UCLA; Indiana University Medical Center; Stanford University Medical Center; Wayne State University; Johns Hopkins Oncology Center; Emory Clinic; Georgetown University Hospital; Memorial Sloan-Kettering Cancer Center; University Hospital, Leiden; Cleveland Clinic Foundation; Hahnemann University Hospital; Kaiser Health Center East; All Children's Hospital; Dartmouth-Hitchcock Medical Center; Baylor University Medical Center; Shands Hospital, University of Florida; University of California, San Diego, Medical Center; University of Wisconsin; Kansas City Internal Medicine; Ohio State University; New England Medical Center; Montefiore Hospital; University of Nebraska Medical Center; City of Hope National Medical Center; Pacific Presbyterian Hospital; University of Connecticut John Dempsey Hospital; Children's Hospital Medical Center; University of California Medical Center; University of Kentucky Medical Center; Hotel Dieu Hospital, Louisiana State University Medical Center; Oklahoma Memorial Hospital; Lawrence Memorial Hospital; George Washington University Hospital; Dana-Farber Cancer Institute; North Carolina Baptist Hospital; and University of Colorado Health Sciences Center.

Abstract Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

Related Letters:

Marrow Transplants from Unrelated Donors
Scornik J. C., Kernan N. A., Hansen J. A., Blume K. G.
Extract | Full Text  
N Engl J Med 1993; 329:362-363, Jul 29, 1993. Correspondence

This article has been cited by other articles:

• Tsao, G. J., Allen, J. A., Logronio, K. A., Lazzeroni, L. C., Shizuru, J. A. (2009). Purified hematopoietic stem cell allografts reconstitute immunity superior to bone marrow. Proc. Natl. Acad. Sci. USA 106: 3288-3293 [Abstract] [Full Text]  
• Schetelig, J., Bornhauser, M., Schmid, C., Hertenstein, B., Schwerdtfeger, R., Martin, H., Stelljes, M., Hegenbart, U., Schafer-Eckart, K., Fussel, M., Wiedemann, B., Thiede, C., Kienast, J., Baurmann, H., Ganser, A., Kolb, H. J., Ehninger, G. (2008). Matched Unrelated or Matched Sibling Donors Result in Comparable Survival After Allogeneic Stem-Cell Transplantation in Elderly Patients With Acute Myeloid Leukemia: A Report From the Cooperative German Transplant Study Group. JCO 26: 5183-5191 [Abstract] [Full Text]  
• Fausel, C. (2007). Targeted chronic myeloid leukemia therapy: Seeking a cure. Am J Health Syst Pharm 64: S9-S15 [Abstract] [Full Text]  
• Kawase, T., Morishima, Y., Matsuo, K., Kashiwase, K., Inoko, H., Saji, H., Kato, S., Juji, T., Kodera, Y., Sasazuki, T., for The Japan Marrow Donor Program, (2007). High-risk HLA allele mismatch combinations responsible for severe acute graft-versus-host disease and implication for its molecular mechanism. Blood 110: 2235-2241 [Abstract] [Full Text]  
• Wagner, J. E., Eapen, M., MacMillan, M. L., Harris, R. E., Pasquini, R., Boulad, F., Zhang, M.-J., Auerbach, A. D. (2007). Unrelated donor bone marrow transplantation for the treatment of Fanconi anemia. Blood 109: 2256-2262 [Abstract] [Full Text]  
• Brunstein, C. G., Weisdorf, D. J., DeFor, T., Barker, J. N., Tolar, J., van Burik, J.-A. H., Wagner, J. E. (2006). Marked increased risk of Epstein-Barr virus-related complications with the addition of antithymocyte globulin to a nonmyeloablative conditioning prior to unrelated umbilical cord blood transplantation. Blood 108: 2874-2880 [Abstract] [Full Text]  
• Deeg, H. J., O'Donnell, M., Tolar, J., Agarwal, R., Harris, R. E., Feig, S. A., Territo, M. C., Collins, R. H., McSweeney, P. A., Copelan, E. A., Khan, S. P., Woolfrey, A., Storer, B. (2006). Optimization of conditioning for marrow transplantation from unrelated donors for patients with aplastic anemia after failure of immunosuppressive therapy. Blood 108: 1485-1491 [Abstract] [Full Text]  
• Chao, N. J. (2006). Umbilical Cord Blood: Biology and Transplantation. aacredbook 2006: 329-333 [Full Text]  
• Pavletic, S. Z., Carter, S. L., Kernan, N. A., Henslee-Downey, J., Mendizabal, A. M., Papadopoulos, E., Gingrich, R., Casper, J., Yanovich, S., Weisdorf, D., for the members of the National Heart, Lung, and B, (2005). Influence of T-cell depletion on chronic graft-versus-host disease: results of a multicenter randomized trial in unrelated marrow donor transplantation. Blood 106: 3308-3313 [Abstract] [Full Text]  
• van Besien, K., Artz, A., Smith, S., Cao, D., Rich, S., Godley, L., Jones, D., Del Cerro, P., Bennett, D., Casey, B., Odenike, O., Thirman, M., Daugherty, C., Wickrema, A., Zimmerman, T., Larson, R.A., Stock, W. (2005). Fludarabine, Melphalan, and Alemtuzumab Conditioning in Adults With Standard-Risk Advanced Acute Myeloid Leukemia and Myelodysplastic Syndrome. JCO 23: 5728-5738 [Abstract] [Full Text]  
• Pavletic, S. Z., Khouri, I. F., Haagenson, M., King, R. J., Bierman, P. J., Bishop, M. R., Carston, M., Giralt, S., Molina, A., Copelan, E. A., Ringden, O., Roy, V., Ballen, K., Adkins, D. R., McCarthy, P., Weisdorf, D., Montserrat, E., Anasetti, C. (2005). Unrelated Donor Marrow Transplantation for B-Cell Chronic Lymphocytic Leukemia After Using Myeloablative Conditioning: Results From the Center for International Blood and Marrow Transplant Research. JCO 23: 5788-5794 [Abstract] [Full Text]  
• Bornstein, R., Flores, A. I., Montalban, M. A., del Rey, M. J., de la Serna, J., Gilsanz, F. (2005). A Modified Cord Blood Collection Method Achieves Sufficient Cell Levels for Transplantation in Most Adult Patients. Stem Cells 23: 324-334 [Abstract] [Full Text]  
• Remberger, M., Beelen, D. W., Fauser, A., Basara, N., Basu, O., Ringden, O. (2005). Increased risk of extensive chronic graft-versus-host disease after allogeneic peripheral blood stem cell transplantation using unrelated donors. Blood 105: 548-551 [Abstract] [Full Text]  
• Takahashi, S., Iseki, T., Ooi, J., Tomonari, A., Takasugi, K., Shimohakamada, Y., Yamada, T., Uchimaru, K., Tojo, A., Shirafuji, N., Kodo, H., Tani, K., Takahashi, T., Yamaguchi, T., Asano, S. (2004). Single-institute comparative analysis of unrelated bone marrow transplantation and cord blood transplantation for adult patients with hematologic malignancies. Blood 104: 3813-3820 [Abstract] [Full Text]  
• Laughlin, M. J., Eapen, M., Rubinstein, P., Wagner, J. E., Zhang, M.-J., Champlin, R. E., Stevens, C., Barker, J. N., Gale, R. P., Lazarus, H. M., Marks, D. I., van Rood, J. J., Scaradavou, A., Horowitz, M. M. (2004). Outcomes after Transplantation of Cord Blood or Bone Marrow from Unrelated Donors in Adults with Leukemia. NEJM 351: 2265-2275 [Abstract] [Full Text]  
• Petersdorf, E. W., Anasetti, C., Martin, P. J., Gooley, T., Radich, J., Malkki, M., Woolfrey, A., Smith, A., Mickelson, E., Hansen, J. A. (2004). Limits of HLA mismatching in unrelated hematopoietic cell transplantation. Blood 104: 2976-2980 [Abstract] [Full Text]  
• Flomenberg, N., Baxter-Lowe, L. A., Confer, D., Fernandez-Vina, M., Filipovich, A., Horowitz, M., Hurley, C., Kollman, C., Anasetti, C., Noreen, H., Begovich, A., Hildebrand, W., Petersdorf, E., Schmeckpeper, B., Setterholm, M., Trachtenberg, E., Williams, T., Yunis, E., Weisdorf, D. (2004). Impact of HLA class I and class II high-resolution matching on outcomes of unrelated donor bone marrow transplantation: HLA-C mismatching is associated with a strong adverse effect on transplantation outcome. Blood 104: 1923-1930 [Abstract] [Full Text]  
• Peters, C., Charnas, L. R., Tan, Y., Ziegler, R. S., Shapiro, E. G., DeFor, T., Grewal, S. S., Orchard, P. J., Abel, S. L., Goldman, A. I., Ramsay, N. K. C., Dusenbery, K. E., Loes, D. J., Lockman, L. A., Kato, S., Aubourg, P. R., Moser, H. W., Krivit, W. (2004). Cerebral X-linked adrenoleukodystrophy: the international hematopoietic cell transplantation experience from 1982 to 1999. Blood 104: 881-888 [Abstract] [Full Text]  
• Zino, E., Frumento, G., Marktel, S., Sormani, M. P., Ficara, F., Terlizzi, S. D., Parodi, A. M., Sergeant, R., Martinetti, M., Bontadini, A., Bonifazi, F., Lisini, D., Mazzi, B., Rossini, S., Servida, P., Ciceri, F., Bonini, C., Lanino, E., Bandini, G., Locatelli, F., Apperley, J., Bacigalupo, A., Ferrara, G. B., Bordignon, C., Fleischhauer, K. (2004). A T-cell epitope encoded by a subset of HLA-DPB1 alleles determines nonpermissive mismatches for hematologic stem cell transplantation. Blood 103: 1417-1424 [Abstract] [Full Text]  
• Chao, N. J., Emerson, S. G., Weinberg, K. I. (2004). Stem Cell Transplantation (Cord Blood Transplants). ASH Education Book 2004: 354-371 [Abstract] [Full Text]  
• Wong, R., Giralt, S. A., Martin, T., Couriel, D. R., Anagnostopoulos, A., Hosing, C., Andersson, B. S., Cano, P., Shahjahan, M., Ippoliti, C., Estey, E. H., McMannis, J., Gajewski, J. L., Champlin, R. E., de Lima, M. (2003). Reduced-intensity conditioning for unrelated donor hematopoietic stem cell transplantation as treatment for myeloid malignancies in patients older than 55 years. Blood 102: 3052-3059 [Abstract] [Full Text]  
• Grewal, S. S., Barker, J. N., Davies, S. M., Wagner, J. E. (2003). Unrelated donor hematopoietic cell transplantation: marrow or umbilical cord blood?. Blood 101: 4233-4244 [Full Text]  
• Niederwieser, D., Maris, M., Shizuru, J. A., Petersdorf, E., Hegenbart, U., Sandmaier, B. M., Maloney, D. G., Storer, B., Lange, T., Chauncey, T., Deininger, M., Ponisch, W., Anasetti, C., Woolfrey, A., Little, M.-T., Blume, K. G., McSweeney, P. A., Storb, R. F. (2003). Low-dose total body irradiation (TBI) and fludarabine followed by hematopoietic cell transplantation (HCT) from HLA-matched or mismatched unrelated donors and postgrafting immunosuppression with cyclosporine and mycophenolate mofetil (MMF) can induce durable complete chimerism and sustained remissions in patients with hematological diseases. Blood 101: 1620-1629 [Abstract] [Full Text]  
• Lang, P., Handgretinger, R., Niethammer, D., Schlegel, P. G., Schumm, M., Greil, J., Bader, P., Engel, C., Scheel-Walter, H., Eyrich, M., Klingebiel, T. (2003). Transplantation of highly purified CD34+ progenitor cells from unrelated donors in pediatric leukemia. Blood 101: 1630-1636 [Abstract] [Full Text]  
• Lee, S. J., Zahrieh, D., Alyea, E. P., Weller, E., Ho, V. T., Antin, J. H., Soiffer, R. J. (2002). Comparison of T-cell-depleted and non-T-cell-depleted unrelated donor transplantation for hematologic diseases: clinical outcomes, quality of life, and costs. Blood 100: 2697-2702 [Abstract] [Full Text]  
• Tabbara, I. A., Zimmerman, K., Morgan, C., Nahleh, Z. (2002). Allogeneic Hematopoietic Stem Cell Transplantation: Complications and Results. Arch Intern Med 162: 1558-1566 [Abstract] [Full Text]  
• Kojima, S., Matsuyama, T., Kato, S., Kigasawa, H., Kobayashi, R., Kikuta, A., Sakamaki, H., Ikuta, K., Tsuchida, M., Hoshi, Y., Morishima, Y., Kodera, Y. (2002). Outcome of 154 patients with severe aplastic anemia who received transplants from unrelated donors: the Japan Marrow Donor Program. Blood 100: 799-803 [Abstract] [Full Text]  
• Ballen, K. K., Becker, P. S., Emmons, R. V. B., Fitzgerald, T. J., Hsieh, C. C., Liu, Q., Heyes, C., Clark, Y., Levy, W., Lambert, J. F., Chiafari, F., Szymanski, I., Rososhansky, S., Popovsky, M. A., Stewart, F. M., Quesenberry, P. J. (2002). Low-dose total body irradiation followed by allogeneic lymphocyte infusion may induce remission in patients with refractory hematologic malignancy. Blood 100: 442-450 [Abstract] [Full Text]  
• La Nasa, G., Giardini, C., Argiolu, F., Locatelli, F., Arras, M., De Stefano, P., Ledda, A., Pizzati, A., Sanna, M. A., Vacca, A., Lucarelli, G., Contu, L. (2002). Unrelated donor bone marrow transplantation for thalassemia: the effect of extended haplotypes. Blood 99: 4350-4356 [Abstract] [Full Text]  
• Silverman, L. R., Demakos, E. P., Peterson, B. L., Kornblith, A. B., Holland, J. C., Odchimar-Reissig, R., Stone, R. M., Nelson, D., Powell, B. L., DeCastro, C. M., Ellerton, J., Larson, R. A., Schiffer, C. A., Holland, J. F. (2002). Randomized Controlled Trial of Azacitidine in Patients With the Myelodysplastic Syndrome: A Study of the Cancer and Leukemia Group B. JCO 20: 2429-2440 [Abstract] [Full Text]  
• Morishima, Y., Sasazuki, T., Inoko, H., Juji, T., Akaza, T., Yamamoto, K., Ishikawa, Y., Kato, S., Sao, H., Sakamaki, H., Kawa, K., Hamajima, N., Asano, S., Kodera, Y. (2002). The clinical significance of human leukocyte antigen (HLA) allele compatibility in patients receiving a marrow transplant from serologically HLA-A, HLA-B, and HLA-DR matched unrelated donors. Blood 99: 4200-4206 [Abstract] [Full Text]  
• Bunin, N., Carston, M., Wall, D., Adams, R., Casper, J., Kamani, N., King, R., the National Marrow Donor Program Working Group, (2002). Unrelated marrow transplantation for children with acute lymphoblastic leukemia in second remission. Blood 99: 3151-3157 [Abstract] [Full Text]  
• Young, N. S. (2002). Acquired Aplastic Anemia. ANN INTERN MED 136: 534-546 [Abstract] [Full Text]  
• Castro-Malaspina, H., Harris, R. E., Gajewski, J., Ramsay, N., Collins, R., Dharan, B., King, R., Deeg, H. J. (2002). Unrelated donor marrow transplantation for myelodysplastic syndromes: outcome analysis in 510 transplants facilitated by the National Marrow Donor Program. Blood 99: 1943-1951 [Abstract] [Full Text]  
• Kushida, T., Inaba, M., Ikebukuro, K., Ichioka, N., Esumi, T., Oyaizu, H., Yoshimura, T., Nagahama, T., Nakamura, K., Ito, T., Hisha, H., Sugiura, K., Yasumizu, R., Iida, H., Ikehara, S. (2002). Comparison of Bone Marrow Cells Harvested from Various Bones of Cynomolgus Monkeys at Various Ages by Perfusion or Aspiration Methods: A Preclinical Study for Human BMT. Stem Cells 20: 155-162 [Abstract] [Full Text]  
• Elmaagacli, A. H., Basoglu, S., Peceny, R., Trenschel, R., Ottinger, H., Lollert, A., Runde, V., Grosse-Wilde, H., Beelen, D. W., Schaefer, U. W. (2002). Improved disease-free-survival after transplantation of peripheral blood stem cells as compared with bone marrow from HLA-identical unrelated donors in patients with first chronic phase chronic myeloid leukemia. Blood 99: 1130-1135 [Abstract] [Full Text]  
• Tzachanis, D., Berezovskaya, A., Nadler, L. M., Boussiotis, V. A. (2002). Blockade of B7/CD28 in mixed lymphocyte reaction cultures results in the generation of alternatively activated macrophages, which suppress T-cell responses. Blood 99: 1465-1473 [Abstract] [Full Text]  
• Drobyski, W. R., Klein, J., Flomenberg, N., Pietryga, D., Vesole, D. H., Margolis, D. A., Keever-Taylor, C. A. (2002). Superior survival associated with transplantation of matched unrelated versus one-antigen-mismatched unrelated or highly human leukocyte antigen- disparate haploidentical family donor marrow grafts for the treatment of hematologic malignancies: establishing a treatment algorithm for recipients of alternative donor grafts. Blood 99: 806-814 [Abstract] [Full Text]  
• Ho, V. T., Soiffer, R. J. (2001). The history and future of T-cell depletion as graft-versus-host disease prophylaxis for allogeneic hematopoietic stem cell transplantation. Blood 98: 3192-3204 [Full Text]  
• Petersdorf, E. W., Kollman, C., Hurley, C. K., Dupont, B., Nademanee, A., Begovich, A. B., Weisdorf, D., McGlave, P. (2001). Effect of HLA class II gene disparity on clinical outcome in unrelated donor hematopoietic cell transplantation for chronic myeloid leukemia: the US National Marrow Donor Program Experience. Blood 98: 2922-2929 [Abstract] [Full Text]  
• Ferrara, G. B., Bacigalupo, A., Lamparelli, T., Lanino, E., Delfino, L., Morabito, A., Parodi, A. M., Pera, C., Pozzi, S., Sormani, M. P., Bruzzi, P., Bordo, D., Bolognesi, M., Bandini, G., Bontadini, A., Barbanti, M., Frumento, G. (2001). Bone marrow transplantation from unrelated donors: the impact of mismatches with substitutions at position 116 of the human leukocyte antigen class I heavy chain. Blood 98: 3150-3155 [Abstract] [Full Text]  
• Kollman, C., Howe, C. W. S., Anasetti, C., Antin, J. H., Davies, S. M., Filipovich, A. H., Hegland, J., Kamani, N., Kernan, N. A., King, R., Ratanatharathorn, V., Weisdorf, D., Confer, D. L. (2001). Donor characteristics as risk factors in recipients after transplantation of bone marrow from unrelated donors: the effect of donor age. Blood 98: 2043-2051 [Abstract] [Full Text]  
• Alpdogan, O., Schmaltz, C., Muriglan, S. J., Kappel, B. J., Perales, M.-A., Rotolo, J. A., Halm, J. A., Rich, B. E., van den Brink, M. R. M. (2001). Administration of interleukin-7 after allogeneic bone marrow transplantation improves immune reconstitution without aggravating graft-versus-host disease. Blood 98: 2256-2265 [Abstract] [Full Text]  
• Remberger, M., Ringden, O., Blau, I.-W., Ottinger, H., Kremens, B., Kiehl, M. G., Aschan, J., Beelen, D. W., Basara, N., Kumlien, G., Fauser, A. A., Runde, V. (2001). No difference in graft-versus-host disease, relapse, and survival comparing peripheral stem cells to bone marrow using unrelated donors. Blood 98: 1739-1745 [Abstract] [Full Text]  
• Williams, T. M. (2001). Human Leukocyte Antigen Gene Polymorphism and the Histocompatibility Laboratory. J. Mol. Diagn. 3: 98-104 [Abstract] [Full Text]  
• Laughlin, M. J., Barker, J., Bambach, B., Koc, O. N., Rizzieri, D. A., Wagner, J. E., Gerson, S. L., Lazarus, H. M., Cairo, M., Stevens, C. E., Rubinstein, P., Kurtzberg, J. (2001). Hematopoietic Engraftment and Survival in Adult Recipients of Umbilical-Cord Blood from Unrelated Donors. NEJM 344: 1815-1822 [Abstract] [Full Text]  
• Cornelissen, J. J., Carston, M., Kollman, C., King, R., Dekker, A. W., Lowenberg, B., Anasetti, C. (2001). Unrelated marrow transplantation for adult patients with poor-risk acute lymphoblastic leukemia: strong graft-versus-leukemia effect and risk factors determining outcome. Blood 97: 1572-1577 [Abstract] [Full Text]  
• Soiffer, R. J., Weller, E., Alyea, E. P., Mauch, P., Webb, I. L., Fisher, D. C., Freedman, A. S., Schlossman, R. L., Gribben, J., Lee, S., Anderson, K. C., Marcus, K., Stone, R. M., Antin, J. H., Ritz, J. (2001). CD6+ Donor Marrow T-Cell Depletion as the Sole Form of Graft-Versus-Host Disease Prophylaxis in Patients Undergoing Allogeneic Bone Marrow Transplant From Unrelated Donors. JCO 19: 1152-1159 [Abstract] [Full Text]  
• Davies, S. M., Kollman, C., Anasetti, C., Antin, J. H., Gajewski, J., Casper, J. T., Nademanee, A., Noreen, H., King, R., Confer, D., Kernan, N. A. (2000). Engraftment and survival after unrelated-donor bone marrow transplantation: a report from the National Marrow Donor Program. Blood 96: 4096-4102 [Abstract] [Full Text]  
• Kushida, T., Inaba, M., Ikebukuro, K., Ngahama, T., Oyaizu, H., Lee, S., Ito, T., Ichioka, N., Hisha, H., Sugiura, K., Miyashima, S., Ageyama, N., Ono, F., Iida, H., Ogawa, R., Ikehara, S. (2000). A New Method for Bone Marrow Cell Harvesting. Stem Cells 18: 453-456 [Abstract] [Full Text]  
• Kojima, S., Hibi, S., Kosaka, Y., Yamamoto, M., Tsuchida, M., Mugishima, H., Sugita, K., Yabe, H., Ohara, A., Tsukimoto, I. (2000). Immunosuppressive therapy using antithymocyte globulin, cyclosporine, and danazol with or without human granulocyte colony-stimulating factor in children with acquired aplastic anemia. Blood 96: 2049-2054 [Abstract] [Full Text]  
• Nash, R. A., Antin, J. H., Karanes, C., Fay, J. W., Avalos, B. R., Yeager, A. M., Przepiorka, D., Davies, S., Petersen, F. B., Bartels, P., Buell, D., Fitzsimmons, W., Anasetti, C., Storb, R., Ratanatharathorn, V. (2000). Phase 3 study comparing methotrexate and tacrolimus with methotrexate and cyclosporine for prophylaxis of acute graft-versus-host disease after marrow transplantation from unrelated donors. Blood 96: 2062-2068 [Abstract] [Full Text]  
• Roux, E., Dumont-Girard, F., Starobinski, M., Siegrist, C.-A., Helg, C., Chapuis, B., Roosnek, E. (2000). Recovery of immune reactivity after T-cell-depleted bone marrow transplantation depends on thymic activity. Blood 96: 2299-2303 [Abstract] [Full Text]  
• Champlin, R. E., Passweg, J. R., Zhang, M.-J., Rowlings, P. A., Pelz, C. J., Atkinson, K. A., Barrett, A. J., Cahn, J.-Y., Drobyski, W. R., Gale, R. P., Goldman, J. M., Gratwohl, A., Gordon-Smith, E. C., Henslee-Downey, P. J., Herzig, R. H., Klein, J. P., Marmont, A. M., O'Reilly, R. J., Ringden, O., Slavin, S., Sobocinski, K. A., Speck, B., Weiner, R. S., Horowitz, M. M. (2000). T-cell depletion of bone marrow transplants for leukemia from donors other than HLA-identical siblings: advantage of T-cell antibodies with narrow specificities. Blood 95: 3996-4003 [Abstract] [Full Text]  
• Godder, K. T., Hazlett, L. J., Abhyankar, S. H., Chiang, K. Y., Christiansen, N. P., Bridges, K. D., Lee, C. G., Geier, S. S., Goon-Johnson, K. S., Gee, A. P., Pati, A. R., Parrish, R. S., Henslee-Downey, P. J. (2000). Partially Mismatched Related-Donor Bone Marrow Transplantation for Pediatric Patients With Acute Leukemia: Younger Donors and Absence of Peripheral Blasts Improve Outcome. JCO 18: 1856-1866 [Abstract] [Full Text]  
• McGlave, P. B., Shu, X. O., Wen, W., Anasetti, C., Nademanee, A., Champlin, R., Antin, J. H., Kernan, N. A., King, R., Weisdorf, D. J. (2000). Unrelated donor marrow transplantation for chronic myelogenous leukemia: 9 years' experience of the National Marrow Donor Program. Blood 95: 2219-2225 [Abstract] [Full Text]  
• Bacigalupo, A., Bruno, B., Saracco, P., Di Bona, E., Locasciulli, A., Locatelli, F., Gabbas, A., Dufour, C., Arcese, W., Testi, G., Broccia, G., Carotenuto, M., Coser, P., Barbui, T., Leoni, P., Ferster, A. (2000). Antilymphocyte globulin, cyclosporine, prednisolone, and granulocyte colony-stimulating factor for severe aplastic anemia: an update of the GITMO/EBMT study on 100 patients. Blood 95: 1931-1934 [Abstract] [Full Text]  
• Vogel, W., Scheding, S., Kanz, L., Brugger, W. (2000). Clinical Applications of CD34+ Peripheral Blood Progenitor Cells (PBPC). Stem Cells 18: 87-92 [Abstract] [Full Text]  
• Lee, S. J., Klar, N., Weeks, J. C., Antin, J. H. (2000). Predicting Costs of Stem-Cell Transplantation. JCO 18: 64-64 [Abstract] [Full Text]  
• de Brabander, C, Cornelissen, J, Smitt, P A E S., Vecht, C. J, van den Bent, M J (2000). Increased incidence of neurological complications in patients receiving an allogenic bone marrow transplantation from alternative donors. J. Neurol. Neurosurg. Psychiatry 68: 36-40 [Abstract] [Full Text]  
• Lowdell, M. W, Koh, M. B C (2000). Immunotherapy of AML: future directions. J. Clin. Pathol. 53: 49-54 [Full Text]  
• Young, N. S., Abkowitz, J. L., Luzzatto, L. (2000). New Insights into the Pathophysiology of Acquired Cytopenias. ASH Education Book 2000: 18-38 [Abstract] [Full Text]  
• Green, A., Clarke, E., Hunt, L., Canterbury, A., Lankester, A., Hale, G., Waldmann, H., Goodman, S., Cornish, J. M., Marks, D. I., Steward, C. G., Oakhill, A., Pamphilon, D. H. (1999). Children With Acute Lymphoblastic Leukemia Who Receive T-Cell-Depleted HLA Mismatched Marrow Allografts From Unrelated Donors Have an Increased Incidence of Primary Graft Failure but a Similar Overall Transplant Outcome. Blood 94: 2236-2246 [Abstract] [Full Text]  
• Lowenberg, B., Downing, J. R., Burnett, A. (1999). Acute Myeloid Leukemia. NEJM 341: 1051-1062 [Full Text]  
• Young, N. S. (1999). Acquired Aplastic Anemia. JAMA 282: 271-278 [Full Text]  
• Socie, G., Stone, J. V., Wingard, J. R., Weisdorf, D., Henslee-Downey, P. J., Bredeson, C., Cahn, J.-Y., Passweg, J. R., Rowlings, P. A., Schouten, H. C., Kolb, H.-J., Klein, J. P., Bender-Gotze, C., Camitta, B. M., Godder, K., Horowitz, M. M., Wayne, A. S., The Late Effects Working Committee of the Internat, (1999). Long-Term Survival and Late Deaths after Allogeneic Bone Marrow Transplantation. NEJM 341: 14-21 [Abstract] [Full Text]  
• Locatelli, F., Rocha, V., Chastang, C., Arcese, W., Michel, G., Abecasis, M., Messina, C., Ortega, J., Badell-Serra, I., Plouvier, E., Souillet, G., Jouet, J.-P., Pasquini, R., Ferreira, E., Garnier, F., Gluckman, E. (1999). Factors Associated With Outcome After Cord Blood Transplantation in Children With Acute Leukemia. Blood 93: 3662-3671 [Abstract] [Full Text]  
• Small, T.N., Papadopoulos, E.B., Boulad, F., Black, P., Castro-Malaspina, H., Childs, B.H., Collins, N., Gillio, A., George, D., Jakubowski, A., Heller, G., Fazzari, M., Kernan, N., MacKinnon, S., Szabolcs, P., Young, J.W., O'Reilly, R.J. (1999). Comparison of Immune Reconstitution After Unrelated and Related T-Cell-Depleted Bone Marrow Transplantation: Effect of Patient Age and Donor Leukocyte Infusions. Blood 93: 467-480 [Abstract] [Full Text]  
• Prasad, V. K., Kernan, N. A., Heller, G., O'Reilly, R. J., Yang, S. Y. (1999). DNA Typing for HLA-A and HLA-B Identifies Disparities Between Patients and Unrelated Donors Matched by HLA-A and HLA-B Serology and HLA-DRB1. Blood 93: 399-409 [Abstract] [Full Text]  
• Dumont-Girard, F., Roux, E., van Lier, R. A., Hale, G., Helg, C., Chapuis, B., Starobinski, M., Roosnek, E. (1998). Reconstitution of the T-Cell Compartment After Bone Marrow Transplantation: Restoration of the Repertoire by Thymic Emigrants. Blood 92: 4464-4471 [Abstract] [Full Text]  
• Rubinstein, P., Carrier, C., Scaradavou, A., Kurtzberg, J., Adamson, J., Migliaccio, A. R., Berkowitz, R. L., Cabbad, M., Dobrila, N. L., Taylor, P. E., Rosenfield, R. E., Stevens, C. E. (1998). Outcomes among 562 Recipients of Placental-Blood Transplants from Unrelated Donors. NEJM 339: 1565-1577 [Abstract] [Full Text]  
• Petersdorf, E. W., Gooley, T. A., Anasetti, C., Martin, P. J., Smith, A. G., Mickelson, E. M., Woolfrey, A. E., Hansen, J. A. (1998). Optimizing Outcome After Unrelated Marrow Transplantation by Comprehensive Matching of HLA Class I and II Alleles in the Donor and Recipient. Blood 92: 3515-3520 [Abstract] [Full Text]  
• Kawano, Y., Takaue, Y., Watanabe, A., Takeda, O., Arai, K., Itoh, E., Ohno, Y., Teshima, T., Harada, M., Watanabe, T., Okamoto, Y., Abe, T., Kajiume, T., Matsushita, T., Ikeda, K., Endo, M., Kuroda, Y., Asano, S., Tanosaki, R., Yamaguchi, K., Law, P., McMannis, J. D. (1998). Partially Mismatched Pediatric Transplants With Allogeneic CD34+ Blood Cells From a Related Donor. Blood 92: 3123-3130 [Abstract] [Full Text]  
• Sasazuki, T., Juji, T., Morishima, Y., Kinukawa, N., Kashiwabara, H., Inoko, H., Yoshida, T., Kimura, A., Akaza, T., Kamikawaji, N., Kodera, Y., Takaku, F., Nose, Y., Ono, T., Sakamaki, T., Kato, S., Akiyama, Y., Okamoto, S., Dohy, H., Harada, M., Asano, S., The Japan Marrow Donor Program, (1998). Effect of Matching of Class I HLA Alleles on Clinical Outcome after Transplantation of Hematopoietic Stem Cells from an Unrelated Donor. NEJM 339: 1177-1185 [Abstract] [Full Text]  
• Aversa, F., Tabilio, A., Velardi, A., Cunningham, I., Terenzi, A., Falzetti, F., Ruggeri, L., Barbabietola, G., Aristei, C., Latini, P., Reisner, Y., Martelli, M. F., Felicini, R., Falcinelli, F., Carotti, A., Perruccio, K., Ballanti, S., Santucci, A., Gambelunghe, C. (1998). Treatment of High-Risk Acute Leukemia with T-Cell-Depleted Stem Cells from Related Donors with One Fully Mismatched HLA Haplotype. NEJM 339: 1186-1193 [Abstract] [Full Text]  
• Drobyski, W. R., Majewski, D., Ozker, K., Hanson, G. (1998). Ex Vivo Anti-CD3 Antibody-Activated Donor T Cells Have a Reduced Ability to Cause Lethal Murine Graft-Versus-Host Disease but Retain Their Ability to Facilitate Alloengraftment. J. Immunol. 161: 2610-2619 [Abstract] [Full Text]  
• Bernstein, S. H., Nademanee, A. P., Vose, J. M., Tricot, G., Fay, J. W., Negrin, R. S., DiPersio, J., Rondon, G., Champlin, R., Barnett, M. J., Cornetta, K., Herzig, G. P., Vaughan, W., Geils, G. Jr, Keating, A., Messner, H., Wolff, S. N., Miller, K. B., Linker, C., Cairo, M., Hellmann, S., Ashby, M., Stryker, S., Nash, R. A. (1998). A Multicenter Study of Platelet Recovery and Utilization in Patients After Myeloablative Therapy and Hematopoietic Stem Cell Transplantation. Blood 91: 3509-3517 [Abstract] [Full Text]  
• Deeg, H. J., Socie, G. (1998). Malignancies After Hematopoietic Stem Cell Transplantation: Many Questions, Some Answers. Blood 91: 1833-1844 [Full Text]  
• Cairo, M. S., Wagner, J. E. (1997). Placental and/or Umbilical Cord Blood: An Alternative Source of Hematopoietic Stem Cells for Transplantation. Blood 90: 4665-4678 [Full Text]  
• Weisdorf, D. J., Billett, A. L., Hannan, P., Ritz, J., Sallan, S. E., Steinbuch, M., Ramsay, N. K.C. (1997). Autologous Versus Unrelated Donor Allogeneic Marrow Transplantation for Acute Lymphoblastic Leukemia. Blood 90: 2962-2968 [Abstract] [Full Text]  
• Sierra, J., Storer, B., Hansen, J. A., Bjerke, J. W., Martin, P. J., Petersdorf, E. W., Appelbaum, F. R., Bryant, E., Chauncey, T. R., Sale, G., Sanders, J. E., Storb, R., Sullivan, K. M., Anasetti, C. (1997). Transplantation of Marrow Cells From Unrelated Donors for Treatment of High-Risk Acute Leukemia: The Effect of Leukemic Burden, Donor HLA-Matching, and Marrow Cell Dose. Blood 89: 4226-4235 [Abstract] [Full Text]  
• Henslee-Downey, P. J., Abhyankar, S. H., Parrish, R. S., Pati, A. R., Godder, K. T., Neglia, W. J., Goon-Johnson, K. S., Geier, S. S., Lee, C. G., Gee, A. P. (1997). Use of Partially Mismatched Related Donors Extends Access to Allogeneic Marrow Transplant. Blood 89: 3864-3872 [Abstract] [Full Text]  
• Brown, K. E., Tisdale, J., Barrett, A. J., Dunbar, C. E., Young, N. S. (1997). Hepatitis-Associated Aplastic Anemia. NEJM 336: 1059-1064 [Abstract] [Full Text]  
• Rottman, G. A., Ramirez, M., Civin, C. I. (1997). Cord Blood Transplantation: A Promising Future. Pediatrics 99: 475-475 [Full Text]  
• Petersdorf, E. W., Longton, G. M., Anasetti, C., Mickelson, E. M., McKinney, S. K., Smith, A. G., Martin, P. J., Hansen, J. A. (1997). Association of HLA-C Disparity With Graft Failure After Marrow Transplantation From Unrelated Donors. Blood 89: 1818-1823 [Abstract] [Full Text]  
• Hauptman, P. J., O'Connor, K. J. (1997). Procurement and Allocation of Solid Organs for Transplantation. NEJM 336: 422-431 [Full Text]  
• Cheson, B. D. (1997). The Myelodysplastic Syndromes. The Oncologist 2: 28-39 [Abstract] [Full Text]  
• Haddad, E., Sulis, M.-L., Jabado, N., Blanche, S., Fischer, A., Tardieu, M. (1997). Frequency and Severity of Central Nervous System Lesions in Hemophagocytic Lymphohistiocytosis. Blood 89: 794-800 [Abstract] [Full Text]  
• Forte, K. J. (1997). Alternative Donor Sources in Pediatric Bone Marrow Transplantation. Journal of Pediatric Oncology Nursing 14: 213-224 [Abstract]  
• Petersdorf, E. W., Longton, G. M., Anasetti, C., Mickelson, E. M., Smith, A. G., Martin, P. J., Hansen, J. A. (1996). Definition of HLA-DQ as a transplantation antigen. Proc. Natl. Acad. Sci. USA 93: 15358-15363 [Abstract] [Full Text]  
• Kurtzberg, J., Laughlin, M., Graham, M. L., Smith, C., Olson, J. F., Halperin, E. C., Ciocci, G., Carrier, C., Stevens, C. E., Rubinstein, P. (1996). Placental Blood as a Source of Hematopoietic Stem Cells for Transplantation into Unrelated Recipients. NEJM 335: 157-166 [Abstract] [Full Text]  
• Pavletic, Z. S., Armitage, J. O. (1996). Bone Marrow Transplantation for Cancer--An Update. The Oncologist 1: 159-168 [Abstract] [Full Text]  
• Kernan, N. A., Dupont, B. (1996). Minor Histocompatibility Antigens and Marrow Transplantation. NEJM 334: 323-324 [Full Text]  
• Silberman, G., Crosse, M. G., Peterson, E. A., Weston, R. C., Horowitz, M. M., Appelbaum, F. R., Cheson, B. D. (1994). Availability and Appropriateness of Allogeneic Bone Marrow Transplantation for Chronic Myeloid Leukemia in 10 Countries. NEJM 331: 1063-1067 [Abstract] [Full Text]  
• Verhoef, L. C.G., De Haan, A. F.J., Van Daal, W. A.J. (1994). Risk Attitude in Gambles with Years of Life: Empirical Support for Prospect Theory. Med Decis Making 14: 194-200 [Abstract]  
• Scornik, J. C., Kernan, N. A., Hansen, J. A., Blume, K. G. (1993). Marrow Transplants from Unrelated Donors. NEJM 329: 362-363 [Full Text]