Risk factors affecting outcome of second HLA-matched sibling donor transplantations for graft failure in severe acquired aplastic anemia.
We examined transplantation outcomes after a second HLA-matched sibling transplantation for primary (16%) or secondary (84%) graft failure in 166 patients with severe acquired aplastic anemia (AA). Two-thirds of these patients has a performance score < 90. In most cases (88%), the same donor was used for both transplants, for both transplantations, and 84% of the second transplantations used bone marrow grafts. We identified 2 prognostic factors: intertransplantation interval (surrogate for primary graft failure and early secondary graft failure) and performance status. Shorter intertransplantation interval (<or= 3 months) and poor performance score (< 90) at second transplantation were associated with high mortality. In patients with a performance score of 90% to 100%, the 8-year probability of overall survival (OS) after second transplantation <or= 3 and > 3 months from first transplantation was 56% and 76%, respectively. The corresponding probabilities in patients with lower performance scores were 33% and 61%. The predominant cause of failure after second transplantation was nonengraftment (in 72 of 166 patients), most commonly in patients with primary or early secondary graft failure (51 of 72; 71%). Our data indicate that novel approaches, including conditioning regimens with greater immunosuppression, should be explored for these patients.
Horan
John T
JT
Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia 30322, USA. john.horan@choa.org
Carreras
Jeanette
J
Tarima
Sergey
S
Camitta
Bruce M
BM
Gale
Robert Peter
RP
Hale
Gregory A
GA
Hinterberger
Wolfgang
W
Marsh
Judith
J
Passweg
Jakob R
JR
Walters
Mark C
MC
Eapen
Mary
M
D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000601:surgery*; D016026:Bone Marrow Transplantation / Q000379:methods*; D002648:Child; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis*; D006410:Hematopoiesis; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D011379:Prognosis; D012086:Reoperation; D012307:Risk Factors; D035781:Siblings; D014019:Tissue Donors; D016896:Treatment Outcome; D055815:Young Adult