title: Allogeneic hematopoietic stem cell transplantation for acquired aplastic anemia using cyclophosphamide and antithymocyte globulin: a single center experience.
abstract: Between February 1998 and October 2007, 97 (69 male, 28 female) patients with acquired aplastic anemia and a median age of 18 years (range, 2-39) received related allogeneic hematopoietic stem cell transplantation. Ninety-five patients received bone marrow grafts and two patients G-CSF primed peripheral blood stem cell transplantation. The donors were genotypically HLA-identical siblings in 94 cases, HLA-matched parents in 2 cases and a syngeneic twin in 1 case. Median time from diagnosis to transplantation was 2 months (range, 1-15). Conditioning regimen consisted of cyclophosphamide combined with antithymocyte globulin in all patients. For graft versus host disease (GVHD) prophylaxis, all patients received methotrexate and cyclosporine. Eighty-six patients showed evidence of hematopoietic engraftment. Eight patients died before engraftment. Rejection rate was 14.8% with three primary graft failures and eight secondary graft rejections occurring between 2 and 27 months post transplantation. Of the 11 rejecting patients, 3 died from infection and 8 proceeded to a second transplantation. Among the eight patients re-transplanted, seven are alive with successful second engraftments and one died from acute grade III GVHD. Acute GVHD occurred in 15.5% and extensive chronic GVHD in only 5.3% of patients. The 4-year overall probability of survival was 76.8%. Infection was the cause of 81.1% of deaths. The major factor affecting survival was onset of infection before transplantation. Major ABO donor-recipient incompatibility, disease severity and acute GVHD had also negative impact on survival. These results could be improved by reducing the time to transplant and by a more efficient supportive care policy.Bone Marrow Transplantation advance online publication, 27 July 2009; doi:10.1038/bmt.2009.175.
authors.affiliation: Centre National de Greffe de Moelle Osseuse (CNGMO), Tunis, Tunisia.
authors.forename: S
authors.initials: S
authors.lastname: Ladeb
authors.forename: A
authors.initials: A
authors.lastname: Abdelkefi
authors.forename: L
authors.initials: L
authors.lastname: Torjman
authors.forename: H
authors.initials: H
authors.lastname: Ben Neji
authors.forename: A
authors.initials: A
authors.lastname: Lakhal
authors.forename: H
authors.initials: H
authors.lastname: Kaabi
authors.forename: L
authors.initials: L
authors.lastname: Ben Hamed
authors.forename: S
authors.initials: S
authors.lastname: Ennigrou
authors.forename: S
authors.initials: S
authors.lastname: Hmida
authors.forename: T
authors.initials: T
authors.lastname: Ben Othman
authors.forename: A
authors.initials: A
authors.lastname: Ben Abdeladhim