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TREATMENT OF HEMATOLOGICAL MALIGNANCIES BY BONE MARROW TRANSPLANTATION FROM VOLUNTEER DONORS

Objective

The goal of the Concerted Action is to increase the number of patients with haematological malignancies and pre-malignancies that can be cured by using unrelated volunteer donor bone marrow transplantation. This is done by promoting the establishing of new registers of volunteer donors as well as increasing the number in existing registries. A coordination of the system for finding an HLA-compatible donor is made. The goal is also to find search prognosis indices that would help to shorten the time to find a donor. The patients will be recruited from more than 100 European Centers to a study that will compare results of transplantation with marrow from unrelated HLA-matched volunteer donors to conventional transplantation with marrow from HLA-matched sibling donors and to autologous bone marrow transplantation.
By promoting the establishment of new registers of volunteer donors as well as increasing the number of existing registries the number of patients with haematological malignancies and premalignancies that can be cured by using unrelated volunteer donor bone marrow transplation may be increased. Coordination of the system for finding an human leukocyte antigen (HLA) compatible donor is carried out.

Steps were taken to establish and expand the activities of the Europe Donor Foundation. National registries were encouraged to report HLA-typed volunteer donors to the foundation in Leiden. These were complied in the book Bone Marrow Donors Woldwide.
A completely computerized system for search requests, search reports, requests for HLA D-related (HLA-DR) typing and information concerning identical donors up to the bone marrow harvesting by dialing on modem lines is under development.

Steps have been taken to establish standardized criteria for HLA typing and the establishment of donor recipient compatibility and attempts have been made to produce a search prognosis index to predict the probability of success in finding a matched unrelated donor.

New registries are being established and existing ones are being reorganized from being mainly procedure oriented (autologous bone marrow transplantation or allogenic bone marrow transplantation) to disease oriented. This has promoted the possibility of comparing different methodologies. The process of comparing the different treatment modalities for patients with major haematological malignancies is just in its infancy. However, based on the results of transplants reported to these registries, preliminary guidelines have been established. Based on these registry data, collaboration with the World Marrow Donor Association has provided recommendations and requirements for a standardized practice throughout the world.

A prospective study has been initiated to compare unrelated donor transplantation to sibling donor transplantation. This study is still recruiting patients.
The Project Managing Group will be responsible for the following sub-projects:

1/ Coordination of donor pools in the joint European and International bone marrow donor world-wide programme.
2/ Establishment of criteria for HLA testing and typing by exchange of sera and cells and for the establishing of compatible criteria.
3/ Finding a search prognosis index to predict probability of success of unrelated donor search.
4/ Establishment of guidelines for indications for search to be initiated.
5/ Recruiting and registering of unrelated donor bone marrow transplants for comparison of outcome with a cohort of identical sibling donor transplants as well as with autologous transplants.

Funding Scheme

CON - Coordination of research actions

Coordinator

Huddinge Hospital
Address

141 Huddinge
Sweden