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.
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Acknowledgements
We express our gratitude to Marco Martinez for his kind assistance with the statistical analysis of the data and Sergio Lozano-Rodriguez for his help in reviewing the manuscript. This article was funded by the Servicio de Hematología, Hospital Universitario ‘Dr José Eleuterio González’ de la Facultad de Medicina de la Universidad Autónoma de Nuevo León, Monterrey, México.
Author contributions
AV-M, DG-A, JRN-C, VA-P, VM, GJ, LV-G, AK-A, AB-A and GJR-A conceived the study, executed the statistical analysis and drafted the manuscript; JCJ-P and CHG-A designed the study and contributed to the manuscript; JG, ALB, SS, GB, SG, AR, SY, GK, JA, JMR, GJ, LR, CF, JV-O, EP-M, SG, EG-L, MAH-R, MMG-A, EH-M, MP-I, GR-G and MAGR-E contributed gathering the information and executing the statistical analysis.
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Gómez-Almaguer, D., Vázquez-Mellado, A., Navarro-Cabrera, J. et al. 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. Bone Marrow Transplant 52, 41–46 (2017). https://doi.org/10.1038/bmt.2016.212
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DOI: https://doi.org/10.1038/bmt.2016.212
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