Unrelated bone marrow transplantation for beta-thalassemia patients: The experience of the Italian Bone Marrow Transplant Group

Ann N Y Acad Sci. 2005:1054:186-95. doi: 10.1196/annals.1345.023.


Bone marrow transplantation (BMT) remains the only potentially curative treatment for patients with thalassemia major. However, most candidates for BMT do not have a suitable family donor. In order to evaluate whether BMT from an HLA-matched unrelated volunteer donor can offer a probability of cure comparable to that obtained when the donor is a compatible sibling, we carried out a study involving 68 thalassemia patients transplanted in six Italian BMT Centers. Thirty-three males and 35 females (age range, 2-37 years; median age, 15) were transplanted from unrelated volunteer donors, all selected using high-resolution molecular typing of both HLA class I and II loci. Fourteen patients were classified in risk class 1; 16 in risk class 2; and 38 in risk class III of the Pesaro classification system. Nine patients (13%) had either primary or secondary graft failure. Fourteen patients (20%) died from transplant-related causes. Grade II-IV acute graft-versus-host disease (GVHD) developed in 24 cases (40%), and chronic GVHD in 10 cases (18%). Overall survival (OS) in the cohort of 68 patients was 79.3% (CI 67-88%), whereas the Kaplan-Meier estimates of disease-free survival (DFS) with transfusion independence was 65.8% (CI 54-77%). In the group of 30 thalassemic patients in risk classes 1 and 2, the probability of OS and DFS were 96.7% (CI 90-100%) and 80.0% (CI 65-94%), respectively, whereas in the 38 patients in class 3 OS was 65.2% (CI 49-80%) and DFS was 54.5% (CI 38-70%). These data show that when donor selection is based on stringent compatibility criteria, the results of unrelated transplantation in thalassemia patients are comparable to those obtained when the donor is a compatible sibling.

Publication types

  • Evaluation Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Blood Transfusion
  • Bone Marrow Transplantation* / mortality
  • Bone Marrow Transplantation* / statistics & numerical data
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Disease-Free Survival
  • Female
  • Graft Rejection / epidemiology
  • Graft vs Host Disease / epidemiology
  • Histocompatibility
  • Humans
  • Immunosuppression Therapy
  • Incidence
  • Italy
  • Life Tables
  • Living Donors
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Assessment
  • Survival Analysis
  • Transplantation Conditioning / mortality
  • Transplantation, Homologous / mortality
  • Transplantation, Homologous / statistics & numerical data
  • Treatment Outcome
  • beta-Thalassemia / genetics
  • beta-Thalassemia / mortality
  • beta-Thalassemia / surgery*
  • beta-Thalassemia / therapy