Successful bone marrow transplantation in children with severe aplastic anemia using HLA-partially matched family donors

F. Locatelli, F. Porta, M. Zecca, P. Pedrazzoli, R. Maccario, S. Giani, V. Vitale, M. Martinetti, E. Mazzolari, A. Lanfranchi, L. Nespoli, A. Bacigalupo, F. Severi

Research output: Contribution to journalArticle

Abstract

Bone marrow transplantation (BMT) using HLA-partially matched family donors has produced disappointing results (25-30% of long-term survivors) in patients with severe aplastic anemia. We describe two children affected by severe aplastic anemia, not responsive to immunosuppressive therapy, who underwent allogeneic bone marrow transplantation using an HLA-partially matched family donor. Both cases presented 2 first class HLA-antigens (A and B) disparity between donor and recipient. The pretransplant conditioning regimen consisted of cyclophosphamide, thoracoabdominal irradiation, cytosine-arabinoside, and antilymphocyte globulin. As graft versus host disease (GVHD) prophylaxis, Cyclosporine-A was administered at usual dosages for 6 months. A full marrow engraftment was observed in both cases. Only grade I acute GVHD, promptly responsive to corticosteroid therapy, developed with no chronic GVHD. Five months after transplant, both children progressively developed hypertension, renal function impairment, thrombocytopenia, and severe normochromic anemia, with erythropoietin serum levels lower than expected for the haematocrit. After antihypertension treatment and supportive therapy the clinical picture progressively improved, while treatment with recombinant human erythropoietin completely corrected the long-lasting anemia. The two children are alive and well 28 months after the transplant, with a Karnofsky score of 100% and a normal peripheral blood count. The authors suggest that, once immunosuppressive therapy has failed, BMT from donors other than HLA-identical sibling is a feasible approach in children affected by severe aplastic anemia, not having an HLA-identical donor.

Original languageEnglish
Pages (from-to)328-333
Number of pages6
JournalAmerican Journal of Hematology
Volume42
Issue number3
Publication statusPublished - 1993

Keywords

  • Bone marrow transplantation
  • Severe aplastic anemia

ASJC Scopus subject areas

  • Hematology

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    Locatelli, F., Porta, F., Zecca, M., Pedrazzoli, P., Maccario, R., Giani, S., Vitale, V., Martinetti, M., Mazzolari, E., Lanfranchi, A., Nespoli, L., Bacigalupo, A., & Severi, F. (1993). Successful bone marrow transplantation in children with severe aplastic anemia using HLA-partially matched family donors. American Journal of Hematology, 42(3), 328-333.