Outcome of unrelated donor stem cell transplantation for children with severe aplastic anemia. Br J Haematol 2008 Apr;141(2):216-23
Date
03/01/2008Pubmed ID
18307564Pubmed Central ID
PMC3164958DOI
10.1111/j.1365-2141.2008.07030.xScopus ID
2-s2.0-40949092342 (requires institutional sign-in at Scopus site) 46 CitationsAbstract
For children with severe aplastic anemia (SAA) who fail immunosuppressive therapy and lack a human leucocyte antigen (HLA)-matched sibling donor, unrelated donors provide a source of hematopoietic stem cells. Data from 195 children with acquired SAA who underwent unrelated donor transplantation between 1989 and 2003 were analyzed. Neutrophil recovery (86% at day-28) was higher with total body irradiation-containing conditioning regimen and in younger recipients (aged < or =16 years) receiving grafts from older donors (aged >40 years). Recovery was lower after mismatched transplants and transplantations prior to 1997. Mortality rates were higher after mismatched transplants, in recipients with a poor performance score, and when the interval between diagnosis and transplantation was longer than 4 years. When restricted to donor-recipient pairs with allele-level HLA typing (8-loci; n = 118), mortality rates were also higher after mismatched transplants and older recipients receiving grafts from older donors; 5-year probabilities of overall survival after HLA-A, -B, -C, -DRB1 matched and mismatched transplants adjusted for donor and recipient age were 57% and 39%, respectively (P = 0.008). The data suggest that unrelated donor transplantation is an acceptable alternative for children; early referral for transplantation and identification of an HLA-matched (allele-level) donor offers the best outcome.
Author List
Perez-Albuerne ED, Eapen M, Klein J, Gross TJ, Lipton JM, Baker KS, Woolfrey A, Kamani NAuthor
Mary Eapen MBBS, DCh, MRCPI, MS Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Acute DiseaseAdolescent
Adult
Anemia, Aplastic
Child
Child, Preschool
Chronic Disease
Graft vs Host Disease
HLA Antigens
Hematopoietic Stem Cell Transplantation
Histocompatibility Testing
Humans
Leukocyte Count
Neutrophils
Survival Analysis
Tissue Donors
Transplantation Conditioning
Treatment Outcome