title: Immunosuppressive Therapy and Bone Marrow Transplantation for Aplastic Anaemia--The CMC Experience.
abstract: This is a single centre experience on the use of immunosuppressive therapy (IST) and stem cell transplantation (SCT) in patients with aplastic anaemia. Between 1985 and December 2013, 530 patients underwent IST while 214 underwent allogeneic SCT. Overall response rate with the use of IST was 58% with higher responses seen in adults (65.1%) compared to children (35.8%) [p = 0.001]. At a median follow up of 34 months (range: 1 - 264), 5 year KM estimates for OS for the entire group is 68.2 ± 2.2%. Loss of response or relapse was seen in 27 responders while clonal evolution to PNH was seen in 8 patients and transformation to MDS or AML was seen in 3. The 5 yr OS for children (45.7 ± 4.7%) was significantly lower than the OS of age groups 16-30 (75.6 ± 3.6%), 31-50 years (76.2 ± 4.2%) and > 50 years (73.0 ±4.2%) (p = 0.0001). SCT was performed in 214 patients with engraftment seen in 91%. The incidence of grade II-IV acute graft versus host disease (GVHD) was 38.4% with grade III-IV GVHD in 11.7%. Chronic GVHD was seen in 47.5% of evaluable patients with majority (73%) being limited chronic GVHD. At a median follow up of 32 months (range: 1 - 244), the 5 year KM estimates of OS for the entire cohort is 64.8 ± 3.3%); The 5 yr OS was significantly higher with the use of Flu/Cy (5 yr OS of 73.8 ± 3.6%) compared to Cy/ATG (5 yr OS of 44.4 ± 9.6%) or Flu/Bu conditioning (5 yr OS of 52.4 ± 8.9%) [p = 0.001]. Imp: SCT and IST offer good response rates and survival in Indian patients with AA except in children receiving IST.
authors.forename: Biju
authors.initials: B
authors.lastname: George
authors.forename: Vikram
authors.initials: V
authors.lastname: Mathews
authors.forename: Auro
authors.initials: A
authors.lastname: Viswabandya
authors.forename: Aby
authors.initials: A
authors.lastname: Abraham
authors.forename: Abhijeet
authors.initials: A
authors.lastname: Ganapule
authors.forename: N A
authors.initials: NA
authors.lastname: Fouzia
authors.forename: Anu
authors.initials: A
authors.lastname: Korula
authors.forename: Kavitha N
authors.initials: KN
authors.lastname: Lakshmi
authors.forename: Mammen
authors.initials: M
authors.lastname: Chandy
authors.forename: Alok
authors.initials: A
authors.lastname: Srivastava
mesh_terms: D000328:Adult; D000741:Anemia, Aplastic / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D001856:Bone Marrow Examination; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000379:methods; D019468:Disease Management; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods / Q000706:statistics & numerical data; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D017063:Outcome Assessment, Health Care; D062072:Patient Acuity; D012189:Retrospective Studies