Outcome of allogeneic hematopoietic cell transplantation from HLA-identical siblings for severe aplastic anemia in patients over 40 years of age

Dario Sangiolo, Rainer Storb, H. Joachim Deeg, Mary E D Flowers, Paul J. Martin, Brenda M. Sandmaier, Hans Peter Kiem, Richard A. Nash, Kris Doney, Wendy M. Leisenring, George Earl Georges

Research output: Contribution to journalArticle

Abstract

Patients with severe aplastic anemia (SAA) over 40 years of age are often not offered treatment with hematopoietic cell transplantation (HCT) because of concerns about treatment-related morbidity or mortality. To evaluate this risk, we analyzed outcomes after allogeneic HCT from HLA-identical sibling donors for all older patients with SAA at our center since 1988. The 23 consecutive patients ranged in age from 40 to 68 years. The conditioning regimen was cyclophosphamide (200 mg/kg) and horse antithymocyte globulin. Methotrexate and cyclosporine were given for postgrafting immunosuppression. The cumulative incidences of grades II, III, and IV acute graft-versus-host-disease were 30%, 4%, and 0%, respectively; that for chronic GVHD was 26%. With a median follow-up of 9.1 years, overall survival was 65%. Documented infections within 1 month before HCT were significantly associated with risk of early treatment-related mortality (P <.001). The median time to discontinuation of posttransplant immunosuppression was 6.2 (range: 5.9-92.0) months. Three patients developed superficial basal cell carcinoma between 5.5 and 15 years after HCT. Our data favor a practice of extending HLA-identical sibling HCT for treatment of SAA in patients older than 40 years of age who are without significant medical comorbidities.

Original languageEnglish
Pages (from-to)1411-1418
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume16
Issue number10
DOIs
Publication statusPublished - Oct 2010

Keywords

  • Aplastic anemia
  • Cyclophosphamide/antithymocyte globulin conditioning
  • Human leukocyte antigen-matched bone marrow transplantation
  • Older age

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Fingerprint Dive into the research topics of 'Outcome of allogeneic hematopoietic cell transplantation from HLA-identical siblings for severe aplastic anemia in patients over 40 years of age'. Together they form a unique fingerprint.

  • Cite this

    Sangiolo, D., Storb, R., Deeg, H. J., Flowers, M. E. D., Martin, P. J., Sandmaier, B. M., Kiem, H. P., Nash, R. A., Doney, K., Leisenring, W. M., & Georges, G. E. (2010). Outcome of allogeneic hematopoietic cell transplantation from HLA-identical siblings for severe aplastic anemia in patients over 40 years of age. Biology of Blood and Marrow Transplantation, 16(10), 1411-1418. https://doi.org/10.1016/j.bbmt.2010.04.005