title: Outcome of allogeneic hematopoietic cell transplantation from HLA-identical siblings for severe aplastic anemia in patients over 40 years of age.
abstract: 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.
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington 98109, USA.
authors.forename: Dario
authors.initials: D
authors.lastname: Sangiolo
authors.forename: Rainer
authors.initials: R
authors.lastname: Storb
authors.forename: H Joachim
authors.initials: HJ
authors.lastname: Deeg
authors.forename: Mary E D
authors.initials: ME
authors.lastname: Flowers
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Martin
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Sandmaier
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Kiem
authors.forename: Richard A
authors.initials: RA
authors.lastname: Nash
authors.forename: Kris
authors.initials: K
authors.lastname: Doney
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Leisenring
authors.forename: George Earl
authors.initials: GE
authors.lastname: Georges
mesh_terms: 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
chemical_list: D006680:HLA Antigens
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