Outcome of allogeneic hematopoietic cell transplantation from HLA-identical siblings for severe aplastic anemia in patients over 40 years of age.
Patients with severe aplastic anemia (SAA) over 40 years of age are often not offered treatment with hematopoietic cell transplantation (HCT) because of concerns about treatment-related morbidity or mortality. To evaluate this risk, we analyzed outcomes after allogeneic HCT from HLA-identical sibling donors for all older patients with SAA at our center since 1988. The 23 consecutive patients ranged in age from 40 to 68 years. The conditioning regimen was cyclophosphamide (200 mg/kg) and horse antithymocyte globulin. Methotrexate and cyclosporine were given for postgrafting immunosuppression. The cumulative incidences of grades II, III, and IV acute graft-versus-host-disease were 30%, 4%, and 0%, respectively; that for chronic GVHD was 26%. With a median follow-up of 9.1 years, overall survival was 65%. Documented infections within 1 month before HCT were significantly associated with risk of early treatment-related mortality (P < .001). The median time to discontinuation of posttransplant immunosuppression was 6.2 (range: 5.9-92.0) months. Three patients developed superficial basal cell carcinoma between 5.5 and 15 years after HCT. Our data favor a practice of extending HLA-identical sibling HCT for treatment of SAA in patients older than 40 years of age who are without significant medical comorbidities.
Sangiolo
Dario
D
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington 98109, USA.
Storb
Rainer
R
Deeg
H Joachim
HJ
Flowers
Mary E D
ME
Martin
Paul J
PJ
Sandmaier
Brenda M
BM
Kiem
Hans-Peter
HP
Nash
Richard A
RA
Doney
Kris
K
Leisenring
Wendy M
WM
Georges
George Earl
GE
D000328:Adult; D000367:Age Factors; D000368:Aged; D000741:Anemia, Aplastic / Q000235:genetics / Q000276:immunology / Q000601:surgery*; D002280:Basal Cell Carcinoma / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000706:statistics & numerical data*; D006648:Histocompatibility; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007239:Infections / Q000453:epidemiology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000453:epidemiology / Q000209:etiology; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology; D012074:Remission Induction; D012189:Retrospective Studies; D035781:Siblings; D012878:Skin Neoplasms / Q000453:epidemiology / Q000209:etiology; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014883:Water-Electrolyte Imbalance / Q000453:epidemiology / Q000209:etiology
D006680:HLA Antigens
Biol Blood Marrow Transplant. 2004 Jul;10(7):494-503
15205670
Ann Intern Med. 2002 Apr 2;136(7):534-46
11926789
Blood. 2003 Feb 15;101(4):1236-42
12393680
JAMA. 2003 Mar 5;289(9):1130-5
12622583
Ann Intern Med. 1999 Feb 2;130(3):193-201
10049197
Biol Blood Marrow Transplant. 2008 Jul;14(7):799-806
18541200
Blood. 1994 Aug 1;84(3):941-9
8043876
Biol Blood Marrow Transplant. 2010 Jan;16(1 Suppl):S119-25
19782144
Br J Haematol. 2005 Sep;130(5):747-51
16115132
N Engl J Med. 1991 May 9;324(19):1297-304
2017225
Ann Intern Med. 1997 Jan 15;126(2):107-15
9005744
Br J Haematol. 2008 Dec;143(5):738-43
19062343
Blood. 1998 May 15;91(10):3637-45
9572999
Semin Hematol. 2000 Jan;37(1):69-80
10676912
Blood. 1976 Jul;48(1):63-70
779871
Biol Blood Marrow Transplant. 2001;7(1):39-44
11215697
Br J Haematol. 1988 Oct;70(2):177-82
3056497
Blood. 1997 Jul 15;90(2):858-64
9226187
Haematologica. 2007 Jan;92(1):11-8
17229630
Haematologica. 2009 Sep;94(9):1312-5
19734425
Blood. 1979 Aug;54(2):477-84
378293
Transplantation. 1994 Feb;57(3):423-6
8108879