CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS Bone marrow transplantation from HLA-identical siblings as treatment for myelodysplasia

Allogeneic hematopoietic stem cell trans-plantation is the only curative therapy for myelodysplasia (MDS). To identify factors influencing transplantation outcome, we studied 452 recipients of HLA-identical sibling transplants for MDS from 1989 to 1997, reported to the International Bone Marrow Transplant Registry. Patients with treatment-related MDS or unclassified MDS were excluded. Median age was 38 years (range, 2-64 years). Sixty percent had refractory anemia with excess blasts (n 136) or with excess blasts in transfor-mation (n 136). Conditioning regimens included total body irradiation in 199 (44%) cases. Marrow was T-cell depleted for 58 (13%) transplants. Cumulative incidences of neutrophil engraftment, grades II-IV acute graft-versus-host disease (GVHD), and chronic GVHD were 91 % (95 % confi-dence interval [CI], 88%-93%), 36 % (95% CI, 31%-40%), and 39 % (95 % CI, 33%-44%), respectively. Three-year transplan-tation-related mortality (TRM), relapse, disease-free survival, and overall surviva