title: Marrow grafts from HLA-identical siblings for severe aplastic anemia: does limiting the number of transplanted marrow cells reduce the risk of chronic GvHD?
abstract: A total of 21 patients with severe aplastic anemia (SAA) underwent marrow transplantation from HLA-identical siblings following a standard conditioning regimen with cyclophosphamide (50 mg/kg/day × 4 days) and horse antithymocyte globulin (30 mg/kg/day × 3 days). Post-grafting immunosuppression consisted of a short course of methotrexate (MTX) combined with cyclosporine (CSP). The transplant protocol tested the hypothesis that the incidence of chronic GvHD could be reduced by limiting the marrow grafts to ⩽2.5 × 108nucleated marrow cells/kg. None of the patients rejected the graft, all had sustained engraftment and all are surviving at a median of 4 (range 1-8) years after transplantation. Chronic GvHD developed in 16% of patients given ⩽2.5 × 108nucleated marrow cells/kg. Post-grafting immunosuppression has been discontinued in 20 of the 21 patients. In conclusion, limiting the number of transplanted marrow cells may have resulted in minimal improvement in the incidence and severity of chronic GvHD.
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Gallo
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.|Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Woolfrey
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.|Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Burroughs
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.|Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA.
authors.forename: B E
authors.initials: BE
authors.lastname: Storer
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.|Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: M E D
authors.initials: ME
authors.lastname: Flowers
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: P
authors.initials: P
authors.lastname: Hari
authors.affiliation: Division of Hematology, Oncology and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Pulsipher
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Heimfeld
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.|Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: H-P
authors.initials: HP
authors.lastname: Kiem
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.|Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: B M
authors.initials: BM
authors.lastname: Sandmaier
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.|Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Storb
mesh_terms: D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000150:complications / Q000628:therapy*; D016026:Bone Marrow Transplantation / Q000379:methods*; D002452:Cell Count; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000517:prevention & control*; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D035781:Siblings; D016896:Treatment Outcome; D055815:Young Adult