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Bone marrow transplantation for severe aplastic anemia: has outcome improved? Blood 1997 Jul 15;90(2):858-64 PMID: 9226187

Pubmed ID

9226187

Abstract

Bone marrow transplants for severe aplastic anemia were first performed in the 1970s. Transplant regimens, supportive care, and patient selection have changed substantially since then. Our objective was to determine the impact of these changes on transplant outcome. We studied 1,305 recipients of HLA-identical sibling transplants for aplastic anemia between 1976 and 1992, reported to the IBMTR by 179 centers. We compared survival of transplants performed in three intervals (1976 through 1980 [n = 186], 1981 through 1987 [n = 648], and 1988 through 1992 [n = 471]) using Cox proportional hazards regression. Five-year survival (+/-95% confidence interval) increased from 48% +/- 7% in the 1976-1980 cohort to 66% +/- 6% in the 1988-1992 cohort (P < .0001). Risks of graft-versus-host disease (GVHD) and interstitial pneumonia decreased over time, but the risk of graft failure did not. Higher long-term survival resulted primarily from decreased mortality in the first 3 months posttransplantation. Late mortality risks were low and changed little over the intervals studied. In multivariate analysis, changes in transplantation strategies accounted for most but not all of the improved outcome. Use of cyclosporine to prevent GVHD was the most important factor. Changes in patient selection did not seem to explain improved survival. Survival after HLA-identical sibling bone marrow transplantations for aplastic anemia has improved since 1976. Changes in GVHD prophylaxis account for much of this improvement. Other changes may also operate.

Author List

Passweg JR, SociƩ G, Hinterberger W, Bacigalupo A, Biggs JC, Camitta BM, Champlin RE, Gale RP, Gluckman E, Gordon-Smith EC, Hows JM, Klein JP, Nugent ML, Pasquini R, Rowlings PA, Speck B, Tichelli A, Zhang MJ, Horowitz MM, Bortin MM

Authors

Bruce M. Camitta MD Clinical Professor in the Medicine department at Medical College of Wisconsin
Mary M. Horowitz MD, MS Center Director, Professor in the Medicine department at Medical College of Wisconsin
Mei-Jie Zhang PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin




Scopus

2-s2.0-0030877514   123 Citations

MESH terms used to index this publication - Major topics in bold

Age Factors
Anemia, Aplastic
Bone Marrow Transplantation
Cohort Studies
Confidence Intervals
Female
Graft Survival
Graft vs Host Disease
Histocompatibility Testing
Humans
Immunosuppression
Lung Diseases, Interstitial
Male
Multivariate Analysis
Proportional Hazards Models
Retrospective Studies
Risk Factors
Survival Rate
Treatment Failure
Treatment Outcome
jenkins-FCD Prod-297 dff1a717c492f00bf6291286365f1f4fe95208f1