Choice of conditioning regimens for bone marrow transplantation in severe aplastic anemia
| Autor: | Christopher C. Dvorak, James Gajewski, Amer Beitinjaneh, Jaap Jan Boelens, David Gómez-Almaguer, Miguel Angel Diaz, Usama Gergis, Hillard M. Lazarus, Mahmoud Aljurf, Joseph H. Antin, Michael A. Pulsipher, Paul J. Orchard, Jean A. Yared, Soyoung Kim, Marta González Vicent, Hisham Abdel-Azim, Kyle Hebert, Andrew R. Gennery, Bipin N. Savani, Ann E. Woolfrey, Biju George, Hasan Hashem, Blachy J. Dávila Saldaña, Kimberly A. Kasow, Natasha Kekre, Olle Ringdén, Daniel J. Weisdorf, Rammurti T. Kamble, Vikram Mathews, Sherif M. Badawy, Kirk R. Schultz, Robert Peter Gale, Siddhartha Ganguly, Mary Eapen, Shahinaz M. Gadalla, Jacek Winiarski, Ibrahim Ahmed, Nelli Bejanyan, Pierre Teira |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Homologous
Adult medicine.medical_specialty Transplantation Conditioning Adolescent Cyclophosphamide Anemia Clinical Decision-Making Graft vs Host Disease Regenerative Medicine Lower risk Severity of Illness Index Gastroenterology Young Adult Rare Diseases Stem Cell Research - Nonembryonic - Human HLA Antigens Internal medicine medicine Humans Transplantation Homologous Bone Marrow Transplantation Transplantation business.industry Prevention Histocompatibility Testing Siblings Aplastic Anemia Aplastic Disease Management Hematology Total body irradiation Stem Cell Research Prognosis medicine.disease Fludarabine Good Health and Well Being Treatment Outcome surgical procedures operative business Busulfan medicine.drug |
| Zdroj: | Blood advances, vol 3, iss 20 |
| ISSN: | 2473-9537 2473-9529 |
| DOI: | 10.1182/bloodadvances.2019000722 |
| Popis: | Allogeneic bone marrow transplantation (BMT) is curative therapy for the treatment of patients with severe aplastic anemia (SAA). However, several conditioning regimens can be used for BMT. We evaluated transplant conditioning regimens for BMT in SAA after HLA-matched sibling and unrelated donor BMT. For recipients of HLA-matched sibling donor transplantation (n = 955), fludarabine (Flu)/cyclophosphamide (Cy)/antithymocyte globulin (ATG) or Cy/ATG led to the best survival. The 5-year probabilities of survival with Flu/Cy/ATG, Cy/ATG, Cy ± Flu, and busulfan/Cy were 91%, 91%, 80%, and 84%, respectively (P = .001). For recipients of 8/8 and 7/8 HLA allele-matched unrelated donor transplantation (n = 409), there were no differences in survival between regimens. The 5-year probabilities of survival with Cy/ATG/total body irradiation 200 cGy, Flu/Cy/ATG/total body irradiation 200 cGy, Flu/Cy/ATG, and Cy/ATG were 77%, 80%, 75%, and 72%, respectively (P = .61). Rabbit-derived ATG compared with equine-derived ATG was associated with a lower risk of grade II to IV acute graft-versus-host disease (GVHD) (hazard ratio [HR], 0.39; P < .001) but not chronic GVHD. Independent of conditioning regimen, survival was lower in patients aged >30 years after HLA-matched sibling (HR, 2.74; P < .001) or unrelated donor (HR, 1.98; P = .001) transplantation. These data support Flu/Cy/ATG and Cy/ATG as optimal regimens for HLA-matched sibling BMT. Although survival after an unrelated donor BMT did not differ between regimens, use of rabbit-derived ATG may be preferred because of lower risks of acute GVHD. |
| Databáze: | OpenAIRE |
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