title: Matched sibling donors versus alternative donors in allogeneic hematopoietic stem cell transplantation for pediatric severe aplastic anemia in México.
abstract: Objectives Hematopoietic stem cell transplantation (HSCT) from a matched sibling donor (MSD) is the preferred initial treatment for children with severe aplastic anemia (SAA). Unfortunately, only about 30% of patients have a suitable human leukocyte antigen-matched sibling. Methods We have analyzed the outcome of 42 patients who received HSCT (22 MSD and 20 alternative donors (AD)) for SAA at the seven major pediatric HSCT centers in Mexico between 2001 and 2013. Results With a median follow-up of 30 months (range, 0.4-144), the 5-year overall survival in children transplanted from MSD was 86.4 + 7.3 vs. 49.5 + 11% for children after AD-HSCT (P = 0.013). The cumulative incidence of treatment-related mortality (TRM) was in the MSD-HSCT 9.1 + 3.9% vs. 47.6 + 9.1% in the AD-HSCT context (P = 0.007). Infectious complications contributed to death (91%) of most patients who received AD-HSCT. Discussion Even when the results of patients given MSD-HSCT are adequate, there is still much room for improvement particularly in children allografted with AD and in the supportive care. The development of an economicwise designed prospective project with MSD or matched unrelated donor HSCTs as a first line of treatment of children with SAA as a unified national trial could address these issues.
authors.affiliation: a Servicio de Hematología del Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León (UANL) , Monterrey , México.
authors.forename: Laura
authors.initials: L
authors.lastname: Rodríguez
authors.affiliation: a Servicio de Hematología del Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León (UANL) , Monterrey , México.
authors.forename: Óscar
authors.initials: Ó
authors.lastname: González-Llano
authors.affiliation: a Servicio de Hematología del Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León (UANL) , Monterrey , México.
authors.forename: Laura
authors.initials: L
authors.lastname: Villarreal
authors.affiliation: a Servicio de Hematología del Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León (UANL) , Monterrey , México.
authors.forename: David
authors.initials: D
authors.lastname: Gómez-Almaguer
authors.affiliation: b Instituto de Investigación en Cáncer Infantil y de la Adolescencia Servicio de Hematología y Oncología Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara , Jalisco , México.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Ortiz
authors.affiliation: c Servicio de Hematología y Oncología, Instituto Nacional de Pediatría, Secretaría de Salud (SSA), Ciudad de México , México.
authors.forename: Alberto
authors.initials: A
authors.lastname: Olaya-Vargas
authors.affiliation: c Servicio de Hematología y Oncología, Instituto Nacional de Pediatría, Secretaría de Salud (SSA), Ciudad de México , México.
authors.forename: Martín
authors.initials: M
authors.lastname: Pérez-García
authors.affiliation: d Centro de Hematología y Medicina Interna de Puebla , Clínica Ruíz , Puebla , México.
authors.forename: Guillermo J
authors.initials: GJ
authors.lastname: Ruíz-Argüelles
authors.affiliation: d Centro de Hematología y Medicina Interna de Puebla , Clínica Ruíz , Puebla , México.
authors.forename: Guillermo J
authors.initials: GJ
authors.lastname: Ruíz-Delgado
authors.affiliation: e Servicio de Hematología y Oncología, Hospital Infantil de México, SSA, Ciudad de México , México.
authors.forename: Teodoro
authors.initials: T
authors.lastname: Muñiz
authors.affiliation: f Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, ISSSTE, Ciudad de México , México.
authors.forename: José
authors.initials: J
authors.lastname: De-Diego
authors.affiliation: f Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, ISSSTE, Ciudad de México , México.
authors.forename: Nancy
authors.initials: N
authors.lastname: Reyes
authors.affiliation: f Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, ISSSTE, Ciudad de México , México.
authors.forename: Victoria
authors.initials: V
authors.lastname: Flores-Villegas
authors.affiliation: g Departamento de Pediatría del Hospital Universitario "Dr. José E. González" , Universidad Autónoma de Nuevo León (UANL) , Monterrey , México.
authors.forename: Julia
authors.initials: J
authors.lastname: Colunga
authors.affiliation: h Servicio de Hematología, UMAE No. 25 IMSS , Monterrey , México.
authors.forename: Adriana
authors.initials: A
authors.lastname: Sandoval
authors.affiliation: b Instituto de Investigación en Cáncer Infantil y de la Adolescencia Servicio de Hematología y Oncología Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara , Jalisco , México.
authors.forename: Óscar
authors.initials: Ó
authors.lastname: González-Ramella
keywords: Alternative donor; Children; Matched sibling donor; Severe acquired aplastic anemia; Stem cell transplantation