title: Current outcome of HLA identical sibling versus unrelated donor transplants in severe aplastic anemia: an EBMT analysis.
abstract: We have analyzed 1448 patients with acquired aplastic anemia grafted between 2005 and 2009, and compared outcome of identical sibling (n=940) versus unrelated donor (n=508) transplants. When compared to the latter, sibling transplants were less likely to be performed beyond 180 days from diagnosis (39% vs. 85%), to have a cytomegalovirus negative donor/recipient status (15% vs. 23%), to receive antithymocyte globulin in the conditioning (52% vs. 61%), and more frequently received marrow as a stem cell source (60% vs. 52%). Unrelated donor grafts had significantly more acute grade II-IV (25% vs. 13%) and significantly more chronic graft-versus-host disease (26% vs. 14%). In multivariate analysis, the risk of death of unrelated donor grafts was higher, but not significantly higher, compared to a sibling donor (P=0.16). The strongest negative predictor of survival was the use of peripheral blood as a stem cell source (P<0.00001), followed by an interval of diagnosis to transplant of 180 days or more (P=0.0005), patient age 20 years or over (P=0.0005), no antithymocyte globulin in the conditioning (P=0.003), and donor/recipient cytomegalovirus sero-status, other than negative/negative (P=0.04). In conclusion, in multivariate analysis, the outcome of unrelated donor transplants for acquired aplastic anemia, is currently not statistically inferior when compared to sibling transplants, although patients are at greater risk of acute and chronic graft-versus-host disease. The use of peripheral blood grafts remains the strongest negative predictor of survival.
authors.affiliation: Divisione Ematologia e Trapianti di Midollo Osseo, IRCCS AOU San Martino-IST, Genova, Italy andrea.bacigalupo@hsanmartino.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
authors.affiliation: Hôpital Saint-Louis, Department of Hematology-BMT, Paris Cedex 10, France.
authors.forename: Gerard
authors.initials: G
authors.lastname: Socié
authors.affiliation: Centre Pierre et Marie Curie, Service Hématologie Greffe de Moëlle, Alger, Algeria.
authors.forename: Rose Marie
authors.initials: RM
authors.lastname: Hamladji
authors.affiliation: King Faisal Specialist Hospital and Research Center, Oncology (Section of Adult Haematolgy/BMT), Riyadh, Saudi Arabia.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Aljurf
authors.affiliation: Federal Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia.
authors.forename: Alexei
authors.initials: A
authors.lastname: Maschan
authors.affiliation: Medical University of Silesia, University Department Haematology and BMT, Katowice, Poland.
authors.forename: Slawomira
authors.initials: S
authors.lastname: Kyrcz-Krzemien
authors.affiliation: Wroclaw Medical University, Department of Children Hematology and Oncology, Bujwida Wroclaw, Poland.
authors.forename: Alicja
authors.initials: A
authors.lastname: Cybicka
authors.affiliation: Rigshospitalet, BMT Unit Department of Hematology L 4042, Department of Bone Marrow Transplantation, University Hospital, Copenhagen, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Sengelov
authors.affiliation: Erciyes Medical School, Dept. of Hematology-Oncology, Kapadokya, BMT Center, Kayseri, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Unal
authors.affiliation: Department of Bone Marrow Transplantation, University Hospital, Essen, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Beelen
authors.affiliation: Ospedale S. Camillo, Haematology and SCT Unit, Padiglione Cesalpino Circonvallazione, Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Locasciulli
authors.affiliation: Institute G. Gaslini, Genova, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Dufour
authors.affiliation: University Hospital, Hematology, Basel, Switzerland.
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Passweg
authors.affiliation: Divisione Ematologia e Trapianti di Midollo Osseo, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Rosi
authors.initials: R
authors.lastname: Oneto
authors.affiliation: Department of Health Science, Medical Statistics, University of Genova, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Signori
authors.affiliation: GKT School of Medicine, Deptartment of Haematological Medicine, King's Denmark Hill Campus, London, UK.
authors.forename: Judith C W
authors.initials: JC
authors.lastname: Marsh
mesh_terms: D000741:Anemia, Aplastic / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors; D035781:Siblings; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D061349:Unrelated Donors
chemical_list: D006680:HLA Antigens