Bone marrow transplantation for severe aplastic anemia--a study of twenty-one Chinese patients in Taiwan.
A total of 21 multiply transfused patients with severe aplastic anemia (SAA) were treated with bone marrow transplantation between March 1985 and September 1990: 20 allogeneic and one syngeneic transplants. A positive response in mixed lymphocyte culture (MLC) was also noted in 7 allogeneic recipients. Pregraft conditioning included high-dose cyclophosphamide (CY) 200 mg/kg over 4 consecutive days, followed by 300 cGy total-body irradiation the day before BMT. Seventeen patients older than 14 years received additional donor buffy-coat cells infusion for 5 days posttransplant. A combination of methotrexate and cyclosporine was used for prophylaxis of graft-versus-host disease. Seventeen patients were alive with a functional graft, and Kaplan-Meier product limit estimates showed a 80.95% probability of survival at 67.7 months. There were 4 deaths: two died of primary graft failure, one from secondary rejection, and the other from chronic GVHD-related complications. Acute GVHD, grade I was noted in only one patient (5.6%). In contrast, chronic GVHD was observed in 10 out of 18 (55.6%) evaluable patients. Venoocclusive liver disease and interstitial pneumonitis were not diagnosed. Our findings indicate that the combination of CY/TBI/BC is well tolerated and results in a low incidence of graft failure/rejection in multiply transfused Chinese patients who received transplants for SAA. The MTX/CsA combination was confirmed as being remarkable in reducing the incidence and severity of acute GVHD. For patients with SAA under the age of 40, with an HLA-identical sibling, we highly recommend BMT as the treatment of choice.
Tzeng
C H
CH
Department of Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China.
Hsieh
R K
RK
Fan
S
S
Liu
J H
JH
Liu
J M
JM
Liu
C J
CJ
Chen
K Y
KY
Yung
C H
CH
Wang
S Y
SY
Wang
S R
SR
D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000453:epidemiology / Q000601:surgery*; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000276:immunology / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D002681:China / Q000208:ethnology; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology; D006801:Humans; D008297:Male; D013624:Taiwan / Q000453:epidemiology