title: [Transplantation of the bone marrow from a HLA-compatible unrelated donor after immunoablative conditioning in children with acquired aplastic anemia unresponsive to combined immunosuppressive therapy: preliminary results].
abstract: OBJECTIVE
  To analyze the efficiency of transplantation of the bone marrow from a HLA-compatible unrelated donor and continued immunosuppressive therapy (IST) in children with aplastic anemia (AA) unresponsive to 2 courses of IST.
  
  
  METHODS
  The study enrolled 14 children aged 2-16 years (median 9 years). A control group comprised 26 patients in whom IST was continued. The median interval between the diagnosis of AA and transplantation was 26 months (9-156 months). The conditioning regimen consisted of thoracoabdominal irradiation in a dose of 2 Gy, fludarabin (Flu) 100-150 mg/m2, cyclophosphamide (Cy) 100-200 mg/kg, antithymocyte globulin (ATG) in 11 patients and Flu, Cy, and ATG in 3. A graft-versus-host reaction was prevented with mycophenolate mefetil in all the patients, tacrolimus in 11, and cyclosporin A in 3. Donors were compatible for high-resolution typing of 10/10 and 9/10 alleles in 8 and 6 patients, respectively; the source of a transplant was bone marrow in 13 patients and granulocyte colony-stimulating factor-mobilized peripheral blood precursors in one case.
  
  
  RESULTS
  Thirteen patients achieved primary engraftment after single transplantation; one patient did after repeat transplantation. Grades I to II graft-versus-host reaction (GVHR) developed in 9 patients; postengraftment life-threatening infections in 3, extensive chronic GVHR in 2, circumscribed GVHR in 7. All fourteen hemopoietic cell transplant recipients followed for a median 17.5 months (range 1-71 months) were survivors.
  
  
  CONCLUSIONS
  The likelihood of good survival after unrelated transplantations in AA is much higher than that after continued IST: 100% versus 15 +/- 11%.
authors.forename: G A
authors.initials: GA
authors.lastname: Novichkova
authors.forename: M A
authors.initials: MA
authors.lastname: Maschan
authors.forename: I P
authors.initials: IP
authors.lastname: Shipitsyna
authors.forename: Iu V
authors.initials: IuV
authors.lastname: Skvortsova
authors.forename: M I
authors.initials: MI
authors.lastname: Persiantseva
authors.forename: L L
authors.initials: LL
authors.lastname: Lebedeva
authors.forename: V O
authors.initials: VO
authors.lastname: Bobrynina
authors.forename: D D
authors.initials: DD
authors.lastname: Baĭdil'dina
authors.forename: O V
authors.initials: OV
authors.lastname: Goronkova
authors.forename: G G
authors.initials: GG
authors.lastname: Solopova
authors.forename: L A
authors.initials: LA
authors.lastname: Khachatrian
authors.forename: U N
authors.initials: UN
authors.lastname: Petrova
authors.forename: E V
authors.initials: EV
authors.lastname: Suntsova
authors.forename: I I
authors.initials: II
authors.lastname: Kalinina
authors.forename: V V
authors.initials: VV
authors.lastname: Sinitsyna
authors.forename: E V
authors.initials: EV
authors.lastname: Skorobogatova
authors.forename: D N
authors.initials: DN
authors.lastname: Balashov
authors.forename: Z M
authors.initials: ZM
authors.lastname: Dyshlevaia
authors.forename: L N
authors.initials: LN
authors.lastname: Shelikhova
authors.forename: E E
authors.initials: EE
authors.lastname: Kurnikova
authors.forename: P E
authors.initials: PE
authors.lastname: Trakhtman
authors.forename: A A
authors.initials: AA
authors.lastname: Maschan
mesh_terms: D000293:Adolescent; D000741:Anemia, Aplastic / Q000188:drug therapy / Q000209:etiology / Q000276:immunology / Q000532:radiotherapy / Q000601:surgery*; D000961:Antilymphocyte Serum / Q000008:administration & dosage / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use*; D018572:Disease-Free Survival; D006085:Graft Survival; D006087:Graft vs Host Reaction / Q000276:immunology; D006680:HLA Antigens / Q000235:genetics; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods*; D017211:Treatment Failure
chemical_list: D000961:Antilymphocyte Serum; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D016572:Cyclosporine