title: The Latin American experience of allografting patients with severe aplastic anaemia: real-world data on the impact of stem cell source and ATG administration in HLA-identical sibling transplants.
abstract: We studied 298 patients with severe aplastic anaemia (SAA) allografted in four Latin American countries. The source of cells was bone marrow (BM) in 94 patients and PBSCs in 204 patients. Engraftment failed in 8.1% of recipients with no difference between BM and PBSCs (P=0.08). Incidence of acute GvHD (aGvHD) for BM and PBSCs was 30% vs 32% (P=0.18), and for grades III-IV was 2.6% vs 11.6% (P=0.01). Chronic GvHD (cGvHD) between BM and PBSCs was 37% vs 59% (P=0.002) and extensive 5% vs 23.6% (P=0.01). OS was 74% vs 76% for BM vs PBSCs (P=0.95). Event-free survival was superior in patients conditioned with anti-thymocyte globulin (ATG)-based regimens compared with other regimens (79% vs 61%, P=0.001) as excessive secondary graft failure was seen with other regimens (10% vs 26%, P=0.005) respectively. In multivariate analysis, aGvHD II-IV (hazard ratio (HR) 2.50, confidence interval (CI) 1.1-5.6, P=0.02) and aGvHD III-IV (HR 8.3 CI 3.4-20.2, P<0.001) proved to be independent negative predictors of survival. In conclusion, BM as a source of cells and ATG-based regimens should be standard because of higher GvHD incidence with PBSCs, although the latter combining with ATG in the conditioning regimen could be an option in selected high-risk patients.
authors.affiliation: Servicio de Hematología, Hospital Universitario de la Universidad Autónoma de Nuevo León, Monterrey, Mexico.
authors.forename: D
authors.initials: D
authors.lastname: Gómez-Almaguer
authors.affiliation: Servicio de Hematología, Hospital Universitario de la Universidad Autónoma de Nuevo León, Monterrey, Mexico.|Laboratorio Corregidora, Querétaro, Mexico.
authors.forename: A
authors.initials: A
authors.lastname: Vázquez-Mellado
authors.affiliation: Servicio de Hematología, Hospital Edgardo Rebagliati, Lima, Peru.
authors.forename: J R
authors.initials: JR
authors.lastname: Navarro-Cabrera
authors.affiliation: Servicio de Hematología, Hospital Clínica de Marly, Bogotá, Colombia.
authors.forename: V
authors.initials: V
authors.lastname: Abello-Polo
authors.affiliation: Hospital Alemán, Buenos Aires, Argentina.
authors.forename: V
authors.initials: V
authors.lastname: Milovic
authors.affiliation: Hospital Privado de Córdoba, Córdoba, Argentina.
authors.forename: J
authors.initials: J
authors.lastname: García
authors.affiliation: Hospital Privado de Córdoba, Córdoba, Argentina.
authors.forename: A L
authors.initials: AL
authors.lastname: Basquiera
authors.affiliation: Hospital Profesor 'Dr Rodolfo Rossi', La Plata, Argentina.
authors.forename: S
authors.initials: S
authors.lastname: Saba
authors.affiliation: Hospital Profesor 'Dr Rodolfo Rossi', La Plata, Argentina.
authors.forename: G
authors.initials: G
authors.lastname: Balladares
authors.affiliation: Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, México City, Mexico.
authors.forename: J
authors.initials: J
authors.lastname: Vela-Ojeda
authors.affiliation: Hospital de Pediatría 'Sor Ludovica', La Plata, Argentina.
authors.forename: S
authors.initials: S
authors.lastname: Gómez
authors.affiliation: Instituto de Cancerología-Clínica las Américas, Medellín Colombia.
authors.forename: A
authors.initials: A
authors.lastname: Karduss-Aurueta
authors.affiliation: Servicio de Hematología, Hospital Edgardo Rebagliati, Lima, Peru.
authors.forename: A
authors.initials: A
authors.lastname: Bustinza-Álvarez
authors.affiliation: Fundación Favaloro, Buenos Aires Argentina.
authors.forename: A
authors.initials: A
authors.lastname: Requejo
authors.affiliation: Fundación Favaloro, Buenos Aires Argentina.
authors.forename: L
authors.initials: L
authors.lastname: Feldman
authors.affiliation: Servicio de Hematología, Hospital Universitario de la Universidad Autónoma de Nuevo León, Monterrey, Mexico.
authors.forename: J C
authors.initials: JC
authors.lastname: Jaime-Pérez
authors.affiliation: Hospital Italiano de La Plata, La Plata, Argentina.
authors.forename: S
authors.initials: S
authors.lastname: Yantorno
authors.affiliation: Hospital Austral, Buenos Aires, Argentina.
authors.forename: G
authors.initials: G
authors.lastname: Kusminsky
authors.affiliation: Servicio de Hematología, Hospital Universitario de la Universidad Autónoma de Nuevo León, Monterrey, Mexico.
authors.forename: C H
authors.initials: CH
authors.lastname: Gutiérrez-Aguirre
authors.affiliation: Hospital Italiano, Buenos Aires, Argentina.
authors.forename: J
authors.initials: J
authors.lastname: Arbelbide
authors.affiliation: Fundación 'Fundaleu', Buenos Aires, Argentina.
authors.forename: J
authors.initials: J
authors.lastname: Martinez-Rolon
authors.affiliation: Sanatorio Allende, Córdoba, Argentina.
authors.forename: G
authors.initials: G
authors.lastname: Jarchum
authors.affiliation: Sanatorio Anchorena, Buenos Aires, Argentina.
authors.forename: G
authors.initials: G
authors.lastname: Jaimovich
authors.affiliation: Cemic, Buenos Aires, Argentina.
authors.forename: L
authors.initials: L
authors.lastname: Riera
authors.affiliation: Servicio de Hematología, Hospital Clínica de Marly, Bogotá, Colombia.
authors.forename: E
authors.initials: E
authors.lastname: Pedraza-Mesa
authors.affiliation: Servicio de Hematología, Hospital Clínica de Marly, Bogotá, Colombia.
authors.forename: L
authors.initials: L
authors.lastname: Villamizar-Gómez
authors.affiliation: Servicio de Hematología, Hospital Universitario de la Universidad Autónoma de Nuevo León, Monterrey, Mexico.
authors.forename: M Á
authors.initials: MÁ
authors.lastname: Herrera-Rojas
authors.affiliation: Servicio de Hematología, Hospital Universitario de la Universidad Autónoma de Nuevo León, Monterrey, Mexico.
authors.forename: M M
authors.initials: MM
authors.lastname: Gamboa-Alonso
authors.affiliation: Instituto Alexander Fleming, Buenos Aires, Argentina.
authors.forename: C
authors.initials: C
authors.lastname: Foncuberta
authors.affiliation: Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, México City, Mexico.
authors.forename: G
authors.initials: G
authors.lastname: Rodríguez-González
authors.affiliation: Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, México City, Mexico.
authors.forename: M A
authors.initials: MA
authors.lastname: García Ruiz-Esparza
authors.affiliation: Servicio de Hematología, Hospital Universitario de la Universidad Autónoma de Nuevo León, Monterrey, Mexico.
authors.forename: E
authors.initials: E
authors.lastname: Hernández-Maldonado
authors.affiliation: Servicio de Hematología, Hospital Universitario de la Universidad Autónoma de Nuevo León, Monterrey, Mexico.
authors.forename: M
authors.initials: M
authors.lastname: Paz-Infanzón
authors.affiliation: Servicio de Hematología, Hospital Universitario de la Universidad Autónoma de Nuevo León, Monterrey, Mexico.
authors.forename: E
authors.initials: E
authors.lastname: González-López
authors.affiliation: Centro de Hematología y Medicina Interna de Puebla Clínica Ruiz, Puebla, Mexico.
authors.forename: G J
authors.initials: GJ
authors.lastname: Ruiz-Argüelles
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D000741:Anemia, Aplastic / Q000401:mortality / Q000628:therapy*; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D006680:HLA Antigens; D006801:Humans; D007843:Latin America; D008297:Male; D008875:Middle Aged; D035781:Siblings; D033581:Stem Cell Transplantation; D015996:Survival Rate
chemical_list: D000961:Antilymphocyte Serum; D006680:HLA Antigens