Current results of bone marrow transplantation in patients with acquired severe aplastic anemia

A. Bacigalupo, R. Oneto, B. Bruno, G. Socié, J. Passweg, A. Locasciulli, M. T. Van Lint, A. Tichelli, S. McCann, J. Marsh, P. Ljungman, J. Hows, P. Marin, H. Schrezenmeier

Research output: Contribution to journalArticlepeer-review

Abstract

We have analyzed 2002 patients grafted in Europe between 1976 and 1998 from an identical twin (n = 34), from an HLA-identical sibling (0 = 1699) or from an alternative donor (0 = 269), which included unrelated and family mismatched donors. The proportions of patients surviving in these three groups are, respectively, 91, 66 and 37%: major causes of failure were acute graft-versus host disease (GvHD) (11%), infection (12%), pneumonitis (4%), rejection (4%). In multivariate Cox analysis, factors predicting outcome were patient's age (p <0.0001), donor type (p <0.0001), interval between diagnosis and bone marrow transplantation (BMT) (p <0.0005), year of BMT (p = 0.0005) and female donor for a male recipient (p = 0.02). Patients were then divided in two groups according to the year of BMT: up to or after 1990. The overall death rate dropped from 43 to 24% (p <0.00001). Improvements were seen mostly for grafts from identical siblings (from 54 to 75%, p <0.0001), and less so for alternative-donor grafts (from 28 to 35%; p = 0.07). Major changes have occurred in the BMT protocol: decreasing use of radiotherapy in the conditioning regimen (from 35 to 24%; p <0.0001) and increasing use of cyclosporin (with or without methotrexate) for GvHD prophylaxis (from 70 to 98%; p <0.0001). In conclusion, the outcome of allogeneic BMT for patients with severe aplastic anemia has considerably improved over the past two decades: young patients, grafted early after diagnosis from an identical sibling, have currently an over 80% chance of long-term survival. Transplants from twins are very successful as well. The risk of complications with alternative donor transplants is still high. Copyright (C) 2000 S. Karger AG, Basel.

Original languageEnglish
Pages (from-to)19-25
Number of pages7
JournalActa Haematologica
Volume103
Issue number1
Publication statusPublished - 2000

Keywords

  • Aplastic anemia
  • Bone marrow transplantation
  • GvHD
  • Radiotherapy
  • Rejection

ASJC Scopus subject areas

  • Hematology

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