title: Comparing Outcomes with Bone Marrow or Peripheral Blood Stem Cells as Graft Source for Matched Sibling Transplants in Severe Aplastic Anemia across Different Economic Regions.
abstract: Bone marrow (BM) is the preferred graft source for hematopoietic stem cell transplantation (HSCT) in severe aplastic anemia (SAA) compared with mobilized peripheral blood stem cells (PBSCs). We hypothesized that this recommendation may not apply to those regions where patients present later in their disease course, with heavier transfusion load and with higher graft failure rates. Patients with SAA who received HSCT from an HLA-matched sibling donor from 1995 to 2009 and reported to the Center for International Blood and Marrow Transplant Research or the Japan Society for Hematopoietic Cell Transplantation were analyzed. The study population was categorized by gross national income per capita and region/countries into 4 groups. Groups analyzed were high-income countries (HIC), which were further divided into United States-Canada (n = 486) and other HIC (n = 1264); upper middle income (UMIC) (n = 482); and combined lower-middle, low-income countries (LM-LIC) (n = 142). In multivariate analysis, overall survival (OS) was highest with BM as graft source in HIC compared with PBSCs in all countries or BM in UMIC or LM-LIC (P < .001). There was no significant difference in OS between BM and PBSCs in UMIC (P = .32) or LM-LIC (P = .23). In LM-LIC the 28-day neutrophil engraftment was higher with PBSCs compared with BM (97% versus 77%, P = .002). Chronic graft-versus-host disease was significantly higher with PBSCs in all groups. Whereas BM should definitely be the preferred graft source for HLA-matched sibling HSCT in SAA, PBSCs may be an acceptable alternative in countries with limited resources when treating patients at high risk of graft failure and infective complications.
authors.affiliation: Department of Medical Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: rkumar@cancercare.mb.ca.
authors.forename: Rajat
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Division of Hematology, National Defense Medical College, Tokorozawa, Japan.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Kimura
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Kwang Woo
authors.initials: KW
authors.lastname: Ahn
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Zhen-Huan
authors.initials: ZH
authors.lastname: Hu
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Yachiyo
authors.initials: Y
authors.lastname: Kuwatsuka
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: John P
authors.initials: JP
authors.lastname: Klein
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Pasquini
authors.affiliation: Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Miyamura
authors.affiliation: Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kato
authors.affiliation: Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany.
authors.forename: Ayami
authors.initials: A
authors.lastname: Yoshimi
authors.affiliation: Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Inamoto
authors.affiliation: Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Ichinohe
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: William Allen
authors.initials: WA
authors.lastname: Wood
authors.affiliation: Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington.
authors.forename: Baldeep
authors.initials: B
authors.lastname: Wirk
authors.affiliation: Department of Medical Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Seftel
authors.affiliation: Calvary Mater Newcastle, HAPS-Pathology North, University of Newcastle, Callaghan, New South Wales, Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: Rowlings
authors.affiliation: Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.affiliation: BC Children's Hospital and Child and Family Research Institute, Vancouver, British Columbia, Canada.
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Schultz
authors.affiliation: Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of Hematology-Oncology, Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium.
authors.forename: Laurence
authors.initials: L
authors.lastname: Dedeken
authors.affiliation: Christian Medical College, Vellore, India.
authors.forename: Biju
authors.initials: B
authors.lastname: George
authors.affiliation: Department of Hematology, University Hospital, Grenoble, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Cahn
authors.affiliation: Department Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Victoria, Australia.
authors.forename: Jeff
authors.initials: J
authors.lastname: Szer
authors.affiliation: BMT Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Jong Wook
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Singapore General Hospital, Singapore, Singapore.
authors.forename: Aloysius Y L
authors.initials: AY
authors.lastname: Ho
authors.affiliation: Department of Pediatrics, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Fasth
authors.affiliation: Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Theresa
authors.initials: T
authors.lastname: Hahn
authors.affiliation: Department of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
authors.forename: Nandita
authors.initials: N
authors.lastname: Khera
authors.affiliation: Rainbow Babies & Children's Hospital/Case Western Reserve University, Cleveland, Ohio.
authors.forename: Jignesh
authors.initials: J
authors.lastname: Dalal
authors.affiliation: Hospital de Clinicas, Federal University of Parana, Curitiba, Brazil.
authors.forename: Carmem
authors.initials: C
authors.lastname: Bonfim
authors.affiliation: Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Aljurf
authors.affiliation: Japanese Data Center for Hematopoietic Cell Transplantation and Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Atsuta
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Wael
authors.initials: W
authors.lastname: Saber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000741:Anemia, Aplastic / Q000401:mortality / Q000628:therapy; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality*; D006801:Humans; D007223:Infant; D007564:Japan; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D012189:Retrospective Studies; D035781:Siblings; D012959:Socioeconomic Factors
keywords: Aplastic anemia; Economic regions; Graft source; Hematopoietic cell transplantation