title: Syngeneic transplantation in aplastic anemia: pre-transplant conditioning and peripheral blood are associated with improved engraftment: an observational study on behalf of the Severe Aplastic Anemia and Pediatric Diseases Working Parties of the European Group for Blood and Marrow Transplantation.
abstract: Aplastic anemia is usually treated with immunosuppression or allogeneic transplant, depending on patient and disease characteristics. Syngeneic transplant offers a rare treatment opportunity with minimal transplant-related mortality, and offers an insight into disease mechanisms. We present here a retrospective analysis of all syngeneic transplants for aplastic anemia reported to the European Group for Blood and Marrow Transplantation. Between 1976 and 2009, 88 patients received 113 transplants. Most transplants (n=85) were preceded by a conditioning regimen, 22 of these including anti-thymocyte globulin. About half of transplants with data available (39 of 86) were followed by posttransplant immunosuppression. Graft source was bone marrow in the majority of cases (n=77). Transplant practice changed over time with more transplants with conditioning and anti-thymocyte globulin as well as peripheral blood stem cells performed in later years. Ten year overall survival was 93% with 5 transplant-related deaths. Graft failure occurred in 32% of transplants. Risk of graft failure was significantly increased in transplants without conditioning, and with bone marrow as graft source. Lack of posttransplant immunosuppression also showed a trend towards increased risk of graft failure, while anti-thymocyte globulin did not have an influence. In summary, syngeneic transplant is associated with a significant risk of graft failure when no conditioning is given, but has an excellent long-term outcome. Furthermore, our comparatively large series enables us to recommend the use of pre-transplant conditioning rather than not and possibly to prefer peripheral blood as a stem cell source.
authors.affiliation: gerulls@uhbs.ch.
authors.forename: Sabine
authors.initials: S
authors.lastname: Gerull
authors.forename: Martin
authors.initials: M
authors.lastname: Stern
authors.forename: Jane
authors.initials: J
authors.lastname: Apperley
authors.forename: Dietrich
authors.initials: D
authors.lastname: Beelen
authors.forename: Lorentz
authors.initials: L
authors.lastname: Brinch
authors.forename: Donald
authors.initials: D
authors.lastname: Bunjes
authors.forename: Andrew
authors.initials: A
authors.lastname: Butler
authors.forename: Arnold
authors.initials: A
authors.lastname: Ganser
authors.forename: Ardeshir
authors.initials: A
authors.lastname: Ghavamzadeh
authors.forename: Mickey B
authors.initials: MB
authors.lastname: Koh
authors.forename: Mieczyslaw
authors.initials: M
authors.lastname: Komarnicki
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kröger
authors.forename: Johan
authors.initials: J
authors.lastname: Maertens
authors.forename: Alexei
authors.initials: A
authors.lastname: Maschan
authors.forename: Christina
authors.initials: C
authors.lastname: Peters
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rovira
authors.forename: Henrik
authors.initials: H
authors.lastname: Sengeløv
authors.forename: Gerard
authors.initials: G
authors.lastname: Socié
authors.forename: Johanna
authors.initials: J
authors.lastname: Tischer
authors.forename: Rosi
authors.initials: R
authors.lastname: Oneto
authors.forename: Jakob
authors.initials: J
authors.lastname: Passweg
authors.forename: Judith
authors.initials: J
authors.lastname: Marsh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000741:Anemia, Aplastic / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D016026:Bone Marrow Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual / Q000639:trends; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010372:Pediatrics / Q000379:methods; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D012720:Severity of Illness Index; D019172:Transplantation Conditioning / Q000379:methods*; D014185:Transplantation, Isogeneic; D055815:Young Adult
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