Current outcome of HLA identical sibling versus unrelated donor transplants in severe aplastic anemia: an EBMT analysis

Andrea Bacigalupo, Gerard Socié, Rose Marie Hamladji, Mahmoud Aljurf, Alexei Maschan, Slawomira Kyrcz-Krzemien, Alicja Cybicka, Henrik Sengelov, Ali Unal, Dietrich Beelen, Anna Locasciulli, Carlo Dufour, Jakob R Passweg, Rosi Oneto, Alessio Signori, Judith C W Marsh, Aplastic Anemia Working Party of the European Group for Blood Marrow Transplantation

    135 Citationer (Scopus)

    Abstract

    We have analyzed 1448 patients with acquired aplastic anemia grafted between 2005 and 2009, and compared outcome of identical sibling (n=940) versus unrelated donor (n=508) transplants. When compared to the latter, sibling transplants were less likely to be performed beyond 180 days from diagnosis (39% vs. 85%), to have a cytomegalovirus negative donor/recipient status (15% vs. 23%), to receive antithymocyte globulin in the conditioning (52% vs. 61%), and more frequently received marrow as a stem cell source (60% vs. 52%). Unrelated donor grafts had significantly more acute grade II-IV (25% vs. 13%) and significantly more chronic graft-versus-host disease (26% vs. 14%). In multivariate analysis, the risk of death of unrelated donor grafts was higher, but not significantly higher, compared to a sibling donor (P=0.16). The strongest negative predictor of survival was the use of peripheral blood as a stem cell source (P<0.00001), followed by an interval of diagnosis to transplant of 180 days or more (P=0.0005), patient age 20 years or over (P=0.0005), no antithymocyte globulin in the conditioning (P=0.003), and donor/recipient cytomegalovirus sero-status, other than negative/negative (P=0.04). In conclusion, in multivariate analysis, the outcome of unrelated donor transplants for acquired aplastic anemia, is currently not statistically inferior when compared to sibling transplants, although patients are at greater risk of acute and chronic graft-versus-host disease. The use of peripheral blood grafts remains the strongest negative predictor of survival.

    OriginalsprogEngelsk
    TidsskriftHaematologica
    Vol/bind100
    Udgave nummer5
    Sider (fra-til)696-702
    Antal sider7
    ISSN0390-6078
    DOI
    StatusUdgivet - maj 2015

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