Patient characteristics
| . | All patients (n = 72) . | Patients who gave blood (n = 33)* . |
|---|---|---|
| Patient sex, male/female (no. of patients) | 38/34 | 16/17 |
| Patient age at transplantation, y, median (range) | 17 (3-40) | 17 (5-36) |
| Donor age at transplantation, y, median (range) | 19 (4-50) | 20 (4-42) |
| Patient age at blood draw, y, median (range) | NA | 39 (28-62) |
| Donor age at blood draw, y, median (range) | NA | 42 (26-53) |
| Donor type, HLA-matched sibling/identical twin (no. of patients) | 66/6 | 30/3 |
| Reason for transplantation, leukemia/aplastic anemia (no. of patients) | 29/43† | 10/23 |
| Cytomegalovirus serostatus before transplantation (patient), positive/negative/unknown (no. of patients) | 6/13/53 | 3/6/24 |
| History of splenectomy, yes/no (no. of patients) | 1/71 | 0/33 |
| Conditioning, TBI + Cy/Cy only/other‡ (no. of patients) | 24/36/12 | 7/19/7 |
| T-cell depletion, yes/no (no. of patients) | 0/72 | 0/33 |
| Donor blood buffy coat cells given in addition to marrow,661-153 yes/no (no. of patients) | 9/57 | 7/23 |
| GVHD prophylaxis,1-153methotrexate67/other (no. of patients) | 64/2 | 29/1 |
| Acute GVHD,1-153 grade 2-3/grade 0-1 (no. of patients) | 13/53 | 5/25 |
| Chronic GVHD (clinical),1-153extensive1-155/none or limited/unknown (no. of patients) | 14/51/1 | 6/24/0 |
| Karnofsky performance score at 20 years after transplantation, 90% or greater/under 90%/unknown (no. of patients) | 62/3/7 | 29/2/2 |
| Posttransplantation conditions potentially impairing immunity (no. of patients) | ||
| Relapse of original disease, yes/no | 21-154/70 | 21-154/31 |
| Secondary malignancy,1-159 yes/no | 14/58 | 5/28 |
| Treatment with chemotherapy, yes/no | 2/70 | 1/32 |
| Chronic hepatitis C, yes/no | 231-160/49 | 151-160/18 |
| Treatment with interferon and/or ribavirin, yes/no | 11/61 | 6/27 |
| Diabetes mellitus,1-164yes/no | 7/65 | 2/31 |
| Obstructive lung disease, yes/no | 31-161/69 | 11-161/32 |
| . | All patients (n = 72) . | Patients who gave blood (n = 33)* . |
|---|---|---|
| Patient sex, male/female (no. of patients) | 38/34 | 16/17 |
| Patient age at transplantation, y, median (range) | 17 (3-40) | 17 (5-36) |
| Donor age at transplantation, y, median (range) | 19 (4-50) | 20 (4-42) |
| Patient age at blood draw, y, median (range) | NA | 39 (28-62) |
| Donor age at blood draw, y, median (range) | NA | 42 (26-53) |
| Donor type, HLA-matched sibling/identical twin (no. of patients) | 66/6 | 30/3 |
| Reason for transplantation, leukemia/aplastic anemia (no. of patients) | 29/43† | 10/23 |
| Cytomegalovirus serostatus before transplantation (patient), positive/negative/unknown (no. of patients) | 6/13/53 | 3/6/24 |
| History of splenectomy, yes/no (no. of patients) | 1/71 | 0/33 |
| Conditioning, TBI + Cy/Cy only/other‡ (no. of patients) | 24/36/12 | 7/19/7 |
| T-cell depletion, yes/no (no. of patients) | 0/72 | 0/33 |
| Donor blood buffy coat cells given in addition to marrow,661-153 yes/no (no. of patients) | 9/57 | 7/23 |
| GVHD prophylaxis,1-153methotrexate67/other (no. of patients) | 64/2 | 29/1 |
| Acute GVHD,1-153 grade 2-3/grade 0-1 (no. of patients) | 13/53 | 5/25 |
| Chronic GVHD (clinical),1-153extensive1-155/none or limited/unknown (no. of patients) | 14/51/1 | 6/24/0 |
| Karnofsky performance score at 20 years after transplantation, 90% or greater/under 90%/unknown (no. of patients) | 62/3/7 | 29/2/2 |
| Posttransplantation conditions potentially impairing immunity (no. of patients) | ||
| Relapse of original disease, yes/no | 21-154/70 | 21-154/31 |
| Secondary malignancy,1-159 yes/no | 14/58 | 5/28 |
| Treatment with chemotherapy, yes/no | 2/70 | 1/32 |
| Chronic hepatitis C, yes/no | 231-160/49 | 151-160/18 |
| Treatment with interferon and/or ribavirin, yes/no | 11/61 | 6/27 |
| Diabetes mellitus,1-164yes/no | 7/65 | 2/31 |
| Obstructive lung disease, yes/no | 31-161/69 | 11-161/32 |
NA indicates not applicable; TBI, total body irradiation; Cy, cyclophosphamide.
Data on late hematopoiesis in 17 patients have been reported.35 In 15 of 16 patients studied more than 97% of donor-derived hematopoiesis was documented, whereas 1 patient had indeterminate chimerism.
One patient had paroxysmal nocturnal hemoglobinuria with hypoplastic marrow.
TBI + Cy denotes total body irradiation (10 Gy) plus cyclophosphamide (120 mg/kg).67 Cy only denotes cyclophosphamide (200 mg/kg).66 Other conditioning regimens contained combinations of chemotherapeutic agents, TBI, and/or antithymocyte globulin.
Allogeneic patients only.
Patients who developed clinical extensive chronic GVHD were treated with glucocorticoids and/or chemotherapy (azathioprine, procarbazine, or cyclophosphamide) for up to 8 years after transplantation. After that they were presumed to be free of clinical extensive chronic GVHD, except for 1 patient (see “Results,” “Deaths”). In 3 of the 14 patients with clinical extensive chronic GVHD, the chronic GVHD was preceded by grade 2-3 acute GVHD.
One patient who underwent transplantation to treat aplastic anemia developed pancytopenia of unknown cause at 26 years after transplantation (the year of the blood draw for our study); his blood cells were of donor origin.35 One patient who underwent transplantation to treat chronic myelogenous leukemia relapsed at 21 years after transplantation (1 year after the blood draw for our study) and received a new transplant; for the purpose of this study the follow-up for infections was stopped at the time of the second transplantation.
Basal cell or squamous cell cancer of the skin in 6 patients, breast cancer in 2 patients, oral and/or esophageal cancer in 2 patients, melanoma in 1 patient, metastatic cancer of unknown primary in 1 patient, and multiple malignancies in 2 patients (thyroid cancer, meningioma, basal cell skin cancer and breast cancer in 1 patient, and basal cell skin cancer and breast cancer in the other patient).
With cirrhosis in 1 patient.
Transient diabetes during glucocorticoid therapy was not counted.
None of the patients had a history of clinical extensive chronic GVHD. One patient underwent lung transplantation for presumed bronchiolitis obliterans at 24 years after transplantation; between the time of lung transplantation and the time of death from chronic lung rejection at 28 years after marrow transplantation, the patient received prednisone, cyclosporine, azathioprine, and sulfamethoxazole/trimethoprim.