scholarly journals Histocompatible unrelated volunteer donors compared with HLA nonidentical family donors in marrow transplantation for aplastic anemia and leukemia

Blood ◽  
1986 ◽  
Vol 68 (6) ◽  
pp. 1322-1328 ◽  
Author(s):  
JM Hows ◽  
JL Yin ◽  
J Marsh ◽  
D Swirsky ◽  
L Jones ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Aplastic Anemia ◽  
Median Survival ◽  
Marrow Transplantation ◽  
Additional Patient ◽  
Unrelated Donor ◽  
Donor Group ◽  
Hla Antigen ◽  
Chronic Granulocytic Leukemia ◽  
Family Donor

Abstract We treated 14 patients by transplantation of marrow from unrelated volunteer donors. Eight patients had severe aplastic anemia, 3 had chronic granulocytic leukemia, and 3 had Fanconi's anemia. The results are compared with those of a group of 14 similar patients transplanted concurrently from human leukocyte antigen (HLA)-mismatched family members: Sustained engraftment was achieved in 8 of 14 patients in both groups; one additional patient survived with autologous marrow reconstitution following an unrelated donor transplant. In the unrelated donor group, 6 of 9 evaluable patients developed grade III through IV acute graft-v-host disease, as compared with 4 of 9 patients after family-mismatched transplants. Overall survival was similar in the two groups. In the unrelated donor group 4 of 14 (29%) patients survived (median survival 1,299 days) as compared with 5 of 14 (36%) in the mismatched-family donor group (median survival 808 days). In both groups, patients with HLA phenotypically matched donors fared better than those with donors who were mismatched for one or more HLA antigen. Of the patients transplanted from HLA phenotypically matched donors 6 of 12 patients (50%) survived, as compared with 3 of 16 patients (19%) transplanted from HLA-mismatched donors. We conclude that unrelated donor bone marrow transplantation (BMT) should be considered in those cases of leukemia or bone marrow failure in which the chance of cure using conventional therapy is remote and a HLA genotypically or phenotypically matched family donor is not available.

scholarly journals Histocompatible unrelated volunteer donors compared with HLA nonidentical family donors in marrow transplantation for aplastic anemia and leukemia

Blood ◽  
1986 ◽  
Vol 68 (6) ◽  
pp. 1322-1328
Author(s):  
JM Hows ◽  
JL Yin ◽  
J Marsh ◽  
D Swirsky ◽  
L Jones ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Aplastic Anemia ◽  
Median Survival ◽  
Marrow Transplantation ◽  
Additional Patient ◽  
Unrelated Donor ◽  
Donor Group ◽  
Hla Antigen ◽  
Chronic Granulocytic Leukemia ◽  
Family Donor

We treated 14 patients by transplantation of marrow from unrelated volunteer donors. Eight patients had severe aplastic anemia, 3 had chronic granulocytic leukemia, and 3 had Fanconi's anemia. The results are compared with those of a group of 14 similar patients transplanted concurrently from human leukocyte antigen (HLA)-mismatched family members: Sustained engraftment was achieved in 8 of 14 patients in both groups; one additional patient survived with autologous marrow reconstitution following an unrelated donor transplant. In the unrelated donor group, 6 of 9 evaluable patients developed grade III through IV acute graft-v-host disease, as compared with 4 of 9 patients after family-mismatched transplants. Overall survival was similar in the two groups. In the unrelated donor group 4 of 14 (29%) patients survived (median survival 1,299 days) as compared with 5 of 14 (36%) in the mismatched-family donor group (median survival 808 days). In both groups, patients with HLA phenotypically matched donors fared better than those with donors who were mismatched for one or more HLA antigen. Of the patients transplanted from HLA phenotypically matched donors 6 of 12 patients (50%) survived, as compared with 3 of 16 patients (19%) transplanted from HLA-mismatched donors. We conclude that unrelated donor bone marrow transplantation (BMT) should be considered in those cases of leukemia or bone marrow failure in which the chance of cure using conventional therapy is remote and a HLA genotypically or phenotypically matched family donor is not available.

scholarly journals Severe aplastic anemia: allogeneic bone marrow transplantation as first-line treatment

2018 ◽  
Vol 2 (15) ◽  
pp. 2020-2028 ◽  
Author(s):  
George E. Georges ◽  
Kris Doney ◽  
Rainer Storb
Keyword(s):  
Bone Marrow ◽  
Aplastic Anemia ◽  
Marrow Transplantation ◽  
Severe Aplastic Anemia ◽  
Unrelated Donor ◽  
Line Treatment ◽  
First Line ◽  
Matched Unrelated Donor ◽  
First Line Treatment

Abstract Treatment of severe aplastic anemia has improved significantly over the past 4 decades. This review will summarize the key areas of progress in the use of allogeneic hematopoietic cell transplantation and nontransplant immunosuppressive therapy (IST) for the treatment of aplastic anemia and then summarize the recommendations for first-line treatment. Based on recent data, we argue that guidelines for the initial treatment of patients with newly diagnosed severe aplastic anemia require revision. At the time of diagnosis, before beginning treatment, HLA typing should be done to identify a marrow donor among family members or in the unrelated donor registries, and a marrow transplant should be considered first-line therapy. The priority order of donor source for bone marrow transplantation is: (1) HLA-identical sibling, (2) HLA-matched unrelated donor, and (3) HLA-haploidentical donor if an HLA-matched unrelated donor is not rapidly available. Each of these donor marrow sources may be preferable to nontransplant IST. We make this recommendation because of the long-term persistent risk for disease relapse and secondary myelodysplastic syndrome or acute myeloid leukemia with the use of nontransplant IST for patients with aplastic anemia. In contrast, marrow transplantation is associated with high cure rates of aplastic anemia and a relatively low risk for graft-versus-host disease, with many patients now living for decades without the risk for disease recurrence or the development of clonal disorders. Implementation of this first-line treatment strategy will provide patients with severe aplastic anemia the best chance of long-term disease-free survival.

Outcomes in Children with Severe Aplastic Anemia Receiving Bone Marrow Transplantation from an HLA-Matched Family Donor or Intensive Immunosuppressive Therapy As First-Line Treatment,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3421-3421 ◽  
Author(s):  
Nao Yoshida ◽  
Akira Kikuchi ◽  
Ryoji Kobayashi ◽  
Hiromasa Yabe ◽  
Yoshiyuki Kosaka ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Aplastic Anemia ◽  
Immunosuppressive Therapy ◽  
Cell Transplantation ◽  
Marrow Transplantation ◽  
Line Treatment ◽  
First Line ◽  
Family Donor ◽  
First Line Treatment

Abstract Abstract 3421 Bone marrow transplantation (BMT) from an HLA-matched family donor (MFD) is the treatment of choice for severe aplastic anemia (SAA) in children. For children without an MFD, immunosuppressive therapy (IST) with a combination of antithymocyte globulin and cyclosporine has been successful. However, this treatment approach is based on the results of comparative studies between these therapies conducted in the 1980s, and the outcomes of both BMT and IST have improved markedly over the past three decades. Therefore, updated evidence for treatment decisions in pediatric SAA is required. In the present study, we compared the outcomes of children with SAA who received IST (subjects enrolled in the prospective multicenter trials of IST conducted by the Japan Childhood Aplastic Anemia Study Group) or BMT from an MFD (subjects registered in the Transplant Registry Unified Management Program conducted by the Japan Society for Hematopoietic Cell Transplantation). The influence of potential risk factors on overall survival (OS) and failure-free survival (FFS) was assessed according to first-line treatment, time period of treatment (1992–1999 and 2000–2009), age and other variables related to each treatment. FFS was defined as survival with treatment response. Death, primary or secondary graft failure, relapse and secondary malignancy were considered treatment failures in patients who received BMT. Death, relapse, disease progression requiring stem cell transplantation from an alternative donor or 2nd IST, clonal evolution and evolution to paroxysmal nocturnal hemoglobinuria were considered treatment failures in patients who received IST. Between 1992 and 2009, 599 children with SAA younger than 17 years received BMT from an MFD (n=213) or IST (n=386) as first-line treatment. While the OS did not differ between patients receiving IST and BMT (88±2% vs. 90±2% at 15 years), FFS was significantly inferior in patients receiving IST as compared to those receiving BMT (54±3% vs. 84±3% at 15 years, P<0.0001). There was no significant improvement in outcomes over the two time periods; OS and FFS at 10 years in 1992–1999 vs. 2000–2009 were 87±2% vs. 93±2% and 66±3% vs. 67±3%, respectively. On multivariate analysis, age <10 years was identified as a favorable factor for OS (P=0.007) and choice of first-line IST was the only unfavorable factor for FFS (P<0.0001). These updated data support the current algorithm for treatment decisions, which recommends BMT when an MFD is available. Disclosures: No relevant conflicts of interest to declare.

BONE MARROW TRANSPLANTATION FOR SEVERE APLASTIC ANEMIA USING A PHENOTYPICALLY HLA-IDENTICAL, SBCOMPATIBLE UNRELATED DONOR

1983 ◽  
Vol 35 (6) ◽  
pp. 566-571 ◽  
Author(s):  
RENE J. DUQUESNOY ◽  
ADRIANA ZEEVI ◽  
MARILYN MARRARI ◽  
SUSAN HACKBARTH ◽  
BRUCE CAMITTA
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Aplastic Anemia ◽  
Marrow Transplantation ◽  
Severe Aplastic Anemia ◽  
Unrelated Donor

Kiedy pacjent jest oporny na leczenie – historia dziewczynki z aplazją szpiku

2020 ◽  
Vol 24 (2) ◽  
Author(s):  
Izabela Marzec ◽  
Katarzyna Pawelec
Keyword(s):  
Bone Marrow ◽  
Aplastic Anemia ◽  
Disease Progression ◽  
Rare Disease ◽  
Immunosuppressive Therapy ◽  
Standard Treatment ◽  
Severe Aplastic Anemia ◽  
Unrelated Donor ◽  
Family Donor ◽  
Haematopoietic System

Acquired aplastic anemia (AAA) is a rare disease of the haematopoietic system in children. In the absence of a compatible family donor of bone marrow, immunosuppressive therapy is used in combination with anti-thymocytic globulin and cyclosporine. We present a 6-year-old girl diagnosed with severe aplastic anemia (SAA), initially treated only with cyclosporine (CSA) due to lack of a drug in Ukraine. In 2 months of therapy, the child was admitted to a Polish clinic. Due to the persistence of aplasia, she received standard treatment with CSA and anti-lymphocyte globulin, to which she did not respond. In view of disease progression and the lack of a completely compatible unrelated donor. It was decided to transplant from a 9/10 compatible donor, which was successful. Now the child is in remission of the disease and has 100% donor chimerism. Despite the difficulties in therapy, the girl has been healthy for over 2 years.

scholarly journals Choice of conditioning regimens for bone marrow transplantation in severe aplastic anemia

2019 ◽  
Vol 3 (20) ◽  
pp. 3123-3131 ◽  
Author(s):  
Nelli Bejanyan ◽  
Soyoung Kim ◽  
Kyle M. Hebert ◽  
Natasha Kekre ◽  
Hisham Abdel-Azim ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Aplastic Anemia ◽  
Marrow Transplantation ◽  
Severe Aplastic Anemia ◽  
Unrelated Donor ◽  
Key Points ◽  
Conditioning Regimens ◽  
Matched Sibling

Key Points Flu/Cy/ATG and Cy/ATG regimens offer the best survival for matched-sibling BMT. Transplantation in patients aged ≥30 years is associated with higher mortality after matched-sibling and unrelated donor BMT.

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