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Allogeneic hematopoietic stem cell transplantation for acquired aplastic anemia using cyclophosphamide and antithymocyte globulin: a single center experience

Bone Marrow Transplantation (2009)Cite this article

A Retraction to this article was published on 13 January 2014

Abstract

Between February 1998 and October 2007, 97 (69 male, 28 female) patients with acquired aplastic anemia and a median age of 18 years (range, 2–39) received related allogeneic hematopoietic stem cell transplantation. Ninety-five patients received bone marrow grafts and two patients G-CSF primed peripheral blood stem cell transplantation. The donors were genotypically HLA-identical siblings in 94 cases, HLA-matched parents in 2 cases and a syngeneic twin in 1 case. Median time from diagnosis to transplantation was 2 months (range, 1–15). Conditioning regimen consisted of cyclophosphamide combined with antithymocyte globulin in all patients. For graft versus host disease (GVHD) prophylaxis, all patients received methotrexate and cyclosporine. Eighty-six patients showed evidence of hematopoietic engraftment. Eight patients died before engraftment. Rejection rate was 14.8% with three primary graft failures and eight secondary graft rejections occurring between 2 and 27 months post transplantation. Of the 11 rejecting patients, 3 died from infection and 8 proceeded to a second transplantation. Among the eight patients re-transplanted, seven are alive with successful second engraftments and one died from acute grade III GVHD. Acute GVHD occurred in 15.5% and extensive chronic GVHD in only 5.3% of patients. The 4-year overall probability of survival was 76.8%. Infection was the cause of 81.1% of deaths. The major factor affecting survival was onset of infection before transplantation. Major ABO donor–recipient incompatibility, disease severity and acute GVHD had also negative impact on survival. These results could be improved by reducing the time to transplant and by a more efficient supportive care policy.

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Authors and Affiliations

  1. Centre National de Greffe de Moelle Osseuse (CNGMO), Tunis, Tunisia

    S Ladeb, A Abdelkefi, L Torjman, H Ben Neji, A Lakhal, T Ben Othman & A Ben Abdeladhim

  2. Centre National de Transfusion Sanguine, Tunis, Tunisia

    H Kaabi, L Ben Hamed & S Hmida

  3. Institut National de la Santé Publique, Tunis, Tunisia

    S Ennigrou

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Correspondence to S Ladeb.

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Ladeb, S., Abdelkefi, A., Torjman, L. et al. Allogeneic hematopoietic stem cell transplantation for acquired aplastic anemia using cyclophosphamide and antithymocyte globulin: a single center experience. Bone Marrow Transplant (2009). https://doi.org/10.1038/bmt.2009.175

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