TUESDAY, Jan. 31 (HealthDay News) -- Infants with severe combined immune deficiency (SCID) are more likely to survive bone marrow transplant if they have an unrelated donor with a human leukocyte antigen (HLA) match than a relative who is HLA-mismatched, investigators report in the Feb. 1 issue of the Journal of the American Medical Association.
A team led by Eyal Grunebaum, M.D., of the University of Toronto in Ontario, Canada, assessed 94 infants with SCID who underwent bone marrow transplant between 1990 and 2004. Thirteen had a family-related HLA-identical donor (RID), 41 had a HLA-matched but unrelated donor (MUD) and 41 had a HLA-mismatched related donor (MMRD).
Survival with RID was 92.3%, with MUD was 80.5% and with MMRD was 52.5% after more than two years of follow-up. Graft failure or the need for repeat bone marrow transplant was highest for those receiving MMRD. Reconstitution of a full T-cell complement was more likely with MUD bone marrow transplant. However, acute graft-versus-host disease occurred in 73.1% of MUD recipients and 45% of MMRD recipients. Interstitial pneumonitis occurred in 35% of MMRD recipients compared with 7.3% of MUD recipients.
The authors conclude that if a related and matched donor is unavailable, it is better to choose bone marrow with a HLA match taken from an unrelated donor than from a donor who is a relative but who doesn't carry a HLA match.
Abstract
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