title: Effect of stem cell source on outcomes after unrelated donor transplantation in severe aplastic anemia.
abstract: Outcome after unrelated donor bone marrow (BM) transplantation for severe aplastic anemia (SAA) has improved, with survival rates now approximately 75%. Increasing use of peripheral blood stem and progenitor cells (PBPCs) instead of BM as a graft source prompted us to compare outcomes of PBPC and BM transplantation for SAA. We studied 296 patients receiving either BM (n = 225) or PBPC (n = 71) from unrelated donors matched at human leukocyte antigen-A, -B, -C, -DRB1. Hematopoietic recovery was similar after PBPC and BM transplantation. Grade 2 to 4 acute graft-versus-host disease risks were higher after transplantation of PBPC compared with BM (hazard ratio = 1.68, P = .02; 48% vs 31%). Chronic graft-versus-host disease risks were not significantly different after adjusting for age at transplantation (hazard ratio = 1.39, P = .14). Mortality risks, independent of age, were higher after PBPC compared with BM transplantation (hazard ratio = 1.62, P = .04; 76% vs 61%). These data indicate that BM is the preferred graft source for unrelated donor transplantation in SAA.
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA. meapen@mcw.edu
authors.forename: Mary
authors.initials: M
authors.lastname: Eapen
authors.forename: Jennifer
authors.initials: J
authors.lastname: Le Rademacher
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
authors.forename: Jeanette
authors.initials: J
authors.lastname: Carreras
authors.forename: Joseph
authors.initials: J
authors.lastname: Fay
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Passweg
authors.forename: Jakub
authors.initials: J
authors.lastname: Tolar
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
authors.forename: Judith C W
authors.initials: JC
authors.lastname: Marsh
authors.forename: H Joachim
authors.initials: HJ
authors.lastname: Deeg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000741:Anemia, Aplastic / Q000401:mortality / Q000601:surgery*; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000453:epidemiology; D006648:Histocompatibility; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009928:Organ Specificity; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult