Hematopoietic stem cell transplantation for acquired aplastic anemia.
There has been a steady improvement in outcomes with allogeneic bone marrow transplantation (BMT) for severe aplastic anemia (SAA), because of progress in optimization of the conditioning regimens, donor hematopoietic cell source, and supportive care. Here, we review recently published data that highlight the improvements and current issues in the treatment of SAA.



Approximately one-third of aplastic anemia patients treated with immune suppressive therapy (IST) have acquired mutations in myeloid cancer candidate genes. Because of the greater probability for eventual failure of IST, human leukocyte antigen (HLA)-matched sibling donor BMT is the first-line of treatment for SAA. HLA-matched unrelated donor (URD) BMT is generally recommended for patients who have failed IST. However, in younger patients for whom a 10/10-HLA-allele matched URD can be rapidly identified, there is a strong rationale to proceed with URD BMT as first-line therapy. HLA-haploidentical BMT using posttransplant cyclophosphamide conditioning regimens is now a reasonable second-line treatment for patients who failed IST.



Improved outcomes have led to an increased first-line role of BMT for treatment of SAA. The optimal cell source from an HLA-matched donor is bone marrow. Additional studies are needed to determine the optimal conditioning regimen for HLA-haploidentical donors.
aClinical Research Division, Fred Hutchinson Cancer Research Center bDepartment of Medicine, University of Washington, Seattle, Washington, USA.
George E
GE
Georges
Rainer
R
Storb
D000741:Anemia, Aplastic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016026:Bone Marrow Transplantation; D002869:Chromosome Aberrations; D020022:Genetic Predisposition to Disease; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology; D006410:Hematopoiesis / Q000235:genetics; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D009154:Mutation; D010455:Peptides / Q000009:adverse effects / Q000627:therapeutic use; D035781:Siblings; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D006680:HLA Antigens; D007166:Immunosuppressive Agents; D010455:Peptides; C515728:thrombopoietin mimetic peptide