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Allografting

Bone marrow transplants from mismatched related and unrelated donors for severe aplastic anemia

Bone Marrow Transplantation volume 37, pages 641–649 (2006)Cite this article

Abstract

For patients with acquired severe aplastic anemia without a matched sibling donor and not responding to immunosuppressive treatment, bone marrow transplantation from a suitable alternative donor is often attempted. We examined risks of graft failure, graft-versus-host disease and overall survival after 318 alternative donor transplants between 1988 and 1998. Sixty-six patients received allografts from 1-antigen and 20 from >1-antigen mismatched related donors; 181 from matched and 51 from mismatched unrelated donors. Most patients were young, had had multiple red blood cell transfusions and poor performance score at transplantation. We did not observe differences in risks of graft failure and overall mortality by donor type. The probabilities of graft failure at 100 days after 1-antigen mismatched related donor, >1-antigen mismatched related donor, matched unrelated donor and mismatched unrelated donor transplants were 21, 25, 15 and 18%, respectively. Corresponding probabilities of overall survival at 5 years were 49, 30, 39 and 36%, respectively. Although alternative donor transplantation results in long-term survival, mortality rates are high. Poor performance score and older age adversely affect outcomes after transplantation. Therefore, early referral for transplantation should be encouraged for patients who fail immunosuppressive therapy and have a suitable alternative donor.

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Acknowledgements

This work was supported by Public Health Service Grant U24-CA76518 from the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, and the National Heart, Lung and Blood Institute; and grants from Aetna; AIG Medical Excess; Allianz Life/Life Trac; American Red Cross; Amgen, Inc.; Anonymous donation to the Medical College of Wisconsin; AnorMED, Inc.; Aventis Pharmaceuticals; Baxter Healthcare Corp.; Baxter Oncology; Berlex Laboratories, Inc.; Biogen IDEC, Inc.; Blue Cross and Blue Shield Association; The Lynde and Harry Bradley Foundation; BRT Laboratories, Inc.; Cedarlane Laboratories Ltd; Celgene Corp.; Cell Pathways; Cell Therapeutics, Inc.; CelMed Biosciences; Centocor, Inc.; Cubist Pharmaceuticals; Dynal Biotech ASA; Edwards Lifesciences RMI; Endo Pharmaceuticals, Inc.; Enzon Pharmaceuticals, Inc.; ESP Pharma; Excess, Inc.; Fujisawa Healthcare, Inc.; Gambro BCT, Inc.; Genzyme; GlaxoSmithKline, Inc.; Human Genome Sciences; ICN Pharmaceuticals, Inc.; ILEX Oncology; Kirin Brewery Company; Ligand Pharmaceuticals, Inc.; Eli Lilly and Company; Nada and Herbert P Mahler Charities; Merck & Company; Millennium Pharmaceuticals; Miller Pharmacal Group; Milliman USA, Inc.; Miltenyi Biotec; The Irving I Moskowitz Foundation; National Leukemia Research Association; National Marrow Donor Program; NeoRx Corporation; Novartis Pharmaceuticals, Inc.; Novo Nordisk Pharmaceuticals; Ortho Biotech, Inc.; Osiris Therapeutics, Inc.; PacifiCare Health Systems; Pall Medical; Pfizer US Pharmaceuticals; Pharmametrics; Pharmion Corp.; Protein Design Labs; QOL Medical; Roche Laboratories; Schering AG; StemCyte, Inc.; StemCell Technologies, Inc.; Stemco Biomedical; StemSoft Software, Inc.; SuperGen, Inc.; Sysmex; THERAKOS, a Johnson & Johnson Co.; University of Colorado Cord Blood Bank; Upside Endeavors; ViaCell, Inc.; ViaCor Biotechnologies; WB Saunders Mosby Churchill; Wellpoint Health Network and Zymogenetics, Inc.

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Authors and Affiliations

  1. Department Innere Medizin, Kantonsspital, Basel, Switzerland

    J R Passweg

  2. Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA

    W S Pérez, M Eapen & M-J Zhang

  3. Medical College of Wisconsin, Milwaukee, WI, USA

    B M Camitta

  4. Hopital Saint Louis, Paris, France

    E Gluckman & G Socié

  5. Donauspital, L. Boltzmann Institute STx, Vienna, Austria

    W Hinterberger

  6. Southmead Hospital, Bristol, UK

    J M Hows

  7. St George's Hospital Medical School, London, UK

    J C W Marsh

  8. Federal University of Parana, Curitiba, Brazil

    R Pasquini

  9. University of Ulm, Ulm, Germany

    H Schrezenmeier

  10. CancerCare Manitoba, Winnipeg, Canada

    C Bredeson

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  1. J R Passweg
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  2. W S Pérez
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  3. M Eapen
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  4. B M Camitta
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  6. W Hinterberger
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  11. G Socié
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  12. M-J Zhang
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Correspondence to J R Passweg.

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Passweg, J., Pérez, W., Eapen, M. et al. Bone marrow transplants from mismatched related and unrelated donors for severe aplastic anemia. Bone Marrow Transplant 37, 641–649 (2006). https://doi.org/10.1038/sj.bmt.1705299

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  • DOI: https://doi.org/10.1038/sj.bmt.1705299

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