Unrelated donor marrow transplantation for treatment of childhood hematologic malignancies-effect of HLA disparity and cell dose.

Abstract

Marrow and hematopoietic cell transplants provide the possibility of a cure for patients with high risk and therapy-resistant leukemia. However the minority of patients are fortunate enough to have an HLA identical sibling. Transplants from HLA matched unrelated donors were of only theoretical interest given the very high degree of polymorphism among HLA antigens throughout the human population and the lack of organized groups of HLA-typed volunteer donors. Demonstration in the early 1980’s that unrelated marrow transplants were medically feasible gave great impetus to the creation of publicly supported donor registries (1-3). In the U.S., a national registry was authorized by congressional legislation in 1984, and in 1986 a federal contract initially administered by the Office of Naval Research was awarded to a consortium of investigators and centers headed by Dr. Jeffrey McCullough of the University of Minnesota (4). This consortium grew to become a comprehensive network of donor recruitment groups, donor centers, marrow and stem cell collection centers, and transplant centers known as the National Marrow Donor Program (NMDP). The NMDP currently consists of 96 donor centers and 127 transplant centers, including 8 donor centers located in countries outside the United States. National registries also exist in several other countries.