Abstract:
:Aplastic anemia is usually treated with immunosuppression or allogeneic transplant, depending on patient and disease characteristics. Syngeneic transplant offers a rare treatment opportunity with minimal transplant-related mortality, and offers an insight into disease mechanisms. We present here a retrospective analysis of all syngeneic transplants for aplastic anemia reported to the European Group for Blood and Marrow Transplantation. Between 1976 and 2009, 88 patients received 113 transplants. Most transplants (n=85) were preceded by a conditioning regimen, 22 of these including anti-thymocyte globulin. About half of transplants with data available (39 of 86) were followed by posttransplant immunosuppression. Graft source was bone marrow in the majority of cases (n=77). Transplant practice changed over time with more transplants with conditioning and anti-thymocyte globulin as well as peripheral blood stem cells performed in later years. Ten year overall survival was 93% with 5 transplant-related deaths. Graft failure occurred in 32% of transplants. Risk of graft failure was significantly increased in transplants without conditioning, and with bone marrow as graft source. Lack of posttransplant immunosuppression also showed a trend towards increased risk of graft failure, while anti-thymocyte globulin did not have an influence. In summary, syngeneic transplant is associated with a significant risk of graft failure when no conditioning is given, but has an excellent long-term outcome. Furthermore, our comparatively large series enables us to recommend the use of pre-transplant conditioning rather than not and possibly to prefer peripheral blood as a stem cell source.
journal_name
Haematologicajournal_title
Haematologicaauthors
Gerull S,Stern M,Apperley J,Beelen D,Brinch L,Bunjes D,Butler A,Ganser A,Ghavamzadeh A,Koh MB,Komarnicki M,Kröger N,Maertens J,Maschan A,Peters C,Rovira M,Sengeløv H,Socié G,Tischer J,Oneto R,Passweg J,Marsh Jdoi
10.3324/haematol.2013.091074subject
Has Abstractpub_date
2013-11-01 00:00:00pages
1804-9issue
11eissn
0390-6078issn
1592-8721pii
haematol.2013.091074journal_volume
98pub_type
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