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Fanconi Anaemia

CsA-based post-graft immunosuppression: the main factor for improving outcome of allografted patients with acquired aplastic anemia. A retrospective survey by the Spanish Group of Hematopoietic Transplantation

Bone Marrow Transplantation volume 29, pages 205–211 (2002)Cite this article

Abstract

A retrospective multicenter study was performed to assess the clinical results in patients with acquired aplastic anemia (AA) allografted over a 19 year period and to identify prognostic factors influencing survival. From April 1978 to December 1997, 176 patients were transplanted. Records from 160 receiving related matched bone marrow transplantation (BMT) were reviewed. Fifty-two percent of the patients were older than 20 years, 5% older than 40; 6.3% were untransfused at BMT and 56.2% had received prior treatments. Conditioning regimens were with chemotherapy in 43.7% of the procedures and with additional irradiation in 56.3%. Graft-versus-host disease (GVHD) prophylaxis was based on cyclosporin A (CsA) in 58.1% of the patients while methotrexate (MTX) was administered to 41.9%. Transplantation earlier on, a longer interval from diagnosis to BMT, GVHD prophylaxis with MTX, graft failure/rejection and acute severe GVHD were adverse factors for survival. The use of CsA emerged as the main factor for the improvement, inducing a significant decrease in graft failure/rejection rate and severe acute GVHD when compared with MTX alone. Radiation-containing regimens decreased the graft failure/rejection rate without improving survival due to the increased risk of acute GVHD. Age and number of transfusions pretransplant did not influence outcome. Survival achieved since 1991 is 79.79%, and graft failure and acute severe GVHD rates are 6.0% and 11.8%, respectively. In conclusion, CsA-based post-graft immunosuppression has been crucial in achieving improved survival in patients with acquired AA up to 40 years of age. Regardless of CsA use, further improvement in survival was apparent with time, probably due to better skills in patient care.

Bone Marrow Transplantation (2002) 29, 205–211. doi:10.1038/sj.bmt.1703349

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Authors and Affiliations

  1. Hematology Department, Hospital Universitario de la Princesa, Madrid, Spain

    R Arranz, FJ Pajuelo & JM Fernández-Rañada

  2. Hematology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain

    E Conde & A Iriondo

  3. Clinical Epidemiology Department, Hospital Universitario de la Princesa, Madrid, Spain

    F Rodriguez-Salvanés

  4. Hematology Department, Clínica Puerta de Hierro, Madrid, Spain

    R Cabrera

  5. Hematology Department, Hospital La Fe, Valencia, Spain

    MA Sanz

  6. Hematology Department, Institut Catalá d’ Oncología, Barcelona, Spain

    J Petit

  7. Hematology Department, Hospital Val d’ Hebrón, Barcelona, Spain

    J Bueno

  8. Hematology Department, Hospital Carlos Haya, Málaga, Spain

    J Maldonado

  9. Hematology Department, Hospital Ramón y Cajal, Madrid, Spain

    J Odriozola

  10. Hematology Department, Hospital Clínico, Valencia, Spain

    JG Conde

  11. Hematology Department, Hospital Sant Pau, Barcelona, Spain

    S Brunet

  12. Hematology Department, Hospital Clinic, Barcelona, Spain

    E Carreras & P Marín

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Arranz, R., Conde, E., Rodriguez-Salvanés, F. et al. CsA-based post-graft immunosuppression: the main factor for improving outcome of allografted patients with acquired aplastic anemia. A retrospective survey by the Spanish Group of Hematopoietic Transplantation. Bone Marrow Transplant 29, 205–211 (2002). https://doi.org/10.1038/sj.bmt.1703349

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