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.
Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia 30322, USA. john.horan@choa.org
John T
JT
Horan
Jeanette
J
Carreras
Sergey
S
Tarima
Bruce M
BM
Camitta
Robert Peter
RP
Gale
Gregory A
GA
Hale
Wolfgang
W
Hinterberger
Judith
J
Marsh
Jakob R
JR
Passweg
Mark C
MC
Walters
Mary
M
Eapen
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