BACKGROUND: Bone marrow has been shown to be superior to peripheral blood, as a stem cell source, in young patients (<20 years of age) with acquired aplastic anemia undergoing a matched sibling transplant. The aim of this study was to test whether this currently also holds true for older patients with acquired aplastic anemia. DESIGN AND METHODS: We analyzed 1886 patients with acquired aplastic anemia who received a first transplant from a human leukocyte antigen identical sibling between 1999 and 2009, with either bone marrow (n=1163) or peripheral blood (n=723) as the source of stem cells. RESULTS: In multivariate Cox analysis negative predictors for survival were: patient's age over 20 years (RR 2.0, P<0.0001), an interval between diagnosis and transplantation of more than 114 days (RR 1.3, P=0.006), no anti-thymocyte globulin in the conditioning (RR 1.6, P=0.0001), a conditioning regimen other than cyclophosphamide (RR=1.3, P=0.008) and the use of peripheral blood as the source of stem cells (RR 1.6, P<0.00001). The survival advantage for recipients of bone marrow rather than peripheral blood was statistically significant in patients aged 1-19 years (90% versus 76% P<0.00001) as well as in patients aged over 20 years (74% versus 64%, P=0.001). The advantage for recipients of bone marrow over peripheral blood was maintained above the age of 50 years (69% versus 39%, P=0.01). Acute and chronic graft-versus-host disease were more frequent in peripheral blood transplants. Major causes of death were graft-versus-host disease (2% versus 6% in bone marrow and peripheral blood recipients, respectively), infections (6% versus 13%), and graft rejection (1.5% versus 2.5%). CONCLUSIONS: This study shows that bone marrow should be the preferred stem cell source for matched sibling transplants in acquired aplastic anemia, in patients of all age groups.
BACKGROUND: Bone marrow has been shown to be superior to peripheral blood, as a stem cell source, in young patients (<20 years of age) with acquired aplastic anemia undergoing a matched sibling transplant. The aim of this study was to test whether this currently also holds true for older patients with acquired aplastic anemia. DESIGN AND METHODS: We analyzed 1886 patients with acquired aplastic anemia who received a first transplant from a human leukocyte antigen identical sibling between 1999 and 2009, with either bone marrow (n=1163) or peripheral blood (n=723) as the source of stem cells. RESULTS: In multivariate Cox analysis negative predictors for survival were: patient's age over 20 years (RR 2.0, P<0.0001), an interval between diagnosis and transplantation of more than 114 days (RR 1.3, P=0.006), no anti-thymocyte globulin in the conditioning (RR 1.6, P=0.0001), a conditioning regimen other than cyclophosphamide (RR=1.3, P=0.008) and the use of peripheral blood as the source of stem cells (RR 1.6, P<0.00001). The survival advantage for recipients of bone marrow rather than peripheral blood was statistically significant in patients aged 1-19 years (90% versus 76% P<0.00001) as well as in patients aged over 20 years (74% versus 64%, P=0.001). The advantage for recipients of bone marrow over peripheral blood was maintained above the age of 50 years (69% versus 39%, P=0.01). Acute and chronic graft-versus-host disease were more frequent in peripheral blood transplants. Major causes of death were graft-versus-host disease (2% versus 6% in bone marrow and peripheral blood recipients, respectively), infections (6% versus 13%), and graft rejection (1.5% versus 2.5%). CONCLUSIONS: This study shows that bone marrow should be the preferred stem cell source for matched sibling transplants in acquired aplastic anemia, in patients of all age groups.
Authors: Judith C Marsh; Vikas Gupta; Ziyi Lim; Aloysius Y Ho; Robin M Ireland; Janet Hayden; Victoria Potter; Mickey B Koh; M Serajul Islam; Nigel Russell; David I Marks; Ghulam J Mufti; Antonio Pagliuca Journal: Blood Date: 2011-04-25 Impact factor: 22.113
Authors: H Joachim Deeg; Barry E Storer; Michael Boeckh; Paul J Martin; Jeannine S McCune; David Myerson; Shelly Heimfeld; Mary E Flowers; Claudio Anasetti; Kristine C Doney; John A Hansen; Hans-Peter Kiem; Richard A Nash; Paul V O'Donnell; Jerald P Radich; Brenda M Sandmaier; Bart L Scott; Mohamed L Sorror; E Houston Warren; Robert P Witherspoon; Ann Woolfrey; Frederick R Appelbaum; Rainer Storb Journal: Biol Blood Marrow Transplant Date: 2006-05 Impact factor: 5.742
Authors: Roland Chu; Ruta Brazauskas; Fangyu Kan; Asad Bashey; Christopher Bredeson; Bruce Camitta; Kuang-Yueh Chiang; Haydar Frangoul; Robert Peter Gale; Adrian Gee; Biju George; Frederick D Goldman; Thomas G Gross; Vikas Gupta; Gregory A Hale; Luis Isola; Alvaro Urbano Ispizua; Hillard Lazarus; Judith Marsh; James Russell; Mitchell Sabloff; Edmund K Waller; Mary Eapen Journal: Biol Blood Marrow Transplant Date: 2010-10-27 Impact factor: 5.742
Authors: Mary Eapen; Jennifer Le Rademacher; Joseph H Antin; Richard E Champlin; Jeanette Carreras; Joseph Fay; Jakob R Passweg; Jakub Tolar; Mary M Horowitz; Judith C W Marsh; H Joachim Deeg Journal: Blood Date: 2011-06-15 Impact factor: 22.113
Authors: H J Deeg; W Leisenring; R Storb; J Nims; M E Flowers; R P Witherspoon; J Sanders; K M Sullivan Journal: Blood Date: 1998-05-15 Impact factor: 22.113
Authors: R Storb; E D Thomas; C D Buckner; R A Clift; F L Johnson; A Fefer; H Glucksberg; E R Giblett; K G Lerner; P Neiman Journal: Blood Date: 1974-02 Impact factor: 22.113
Authors: S Ladeb; A Abdelkefi; L Torjman; H Ben Neji; A Lakhal; H Kaabi; L Ben Hamed; S Ennigrou; S Hmida; T Ben Othman; A Ben Abdeladhim Journal: Bone Marrow Transplant Date: 2009-07-27 Impact factor: 5.483
Authors: S Masouridi-Levrat; F Simonetta; Y Beauverd; O Tsopra; Y Tirefort; C Stephan; E Levrat; M Ansari; F Verholen; E Roosnek; J R Passweg; Y Chalandon Journal: Bone Marrow Transplant Date: 2016-02-08 Impact factor: 5.483
Authors: Anita J Kumar; Soyoung Kim; Michael T Hemmer; Mukta Arora; Stephen R Spellman; Joseph A Pidala; Daniel R Couriel; Amin M Alousi; Mahmoud D Aljurf; Jean-Yves Cahn; Mitchell S Cairo; Corey S Cutler; Shatha Farhan; Usama Gergis; Gregory A Hale; Shahrukh K Hashmi; Yoshihiro Inamoto; Rammurti T Kamble; Mohamed A Kharfan-Dabaja; Margaret L MacMillan; David I Marks; Hideki Nakasone; Maxim Norkin; Muna Qayed; Olle Ringden; Harry C Schouten; Kirk R Schultz; Melhem M Solh; Takanori Teshima; Alvaro Urbano-Ispizua; Leo F Verdonck; Robert Peter Gale; Betty K Hamilton; Navneet S Majhail; Alison W Loren Journal: Blood Adv Date: 2018-05-08
Authors: Michael J Eckrich; Kwang-Woo Ahn; Richard E Champlin; Peter Coccia; Kamar Godder; John Horan; David Margolis; H Joachim Deeg; Mary Eapen Journal: Am J Hematol Date: 2013-11-15 Impact factor: 10.047
Authors: Yoshihiro Inamoto; Mary E D Flowers; Tao Wang; Alvaro Urbano-Ispizua; Michael T Hemmer; Corey S Cutler; Daniel R Couriel; Amin M Alousi; Joseph H Antin; Robert Peter Gale; Vikas Gupta; Betty K Hamilton; Mohamed A Kharfan-Dabaja; David I Marks; Olle T H Ringdén; Gérard Socié; Melhem M Solh; Görgün Akpek; Mitchell S Cairo; Nelson J Chao; Robert J Hayashi; Taiga Nishihori; Ran Reshef; Ayman Saad; Ami Shah; Takanori Teshima; Martin S Tallman; Baldeep Wirk; Stephen R Spellman; Mukta Arora; Paul J Martin Journal: Biol Blood Marrow Transplant Date: 2015-05-30 Impact factor: 5.742
Authors: Christopher J Gamper; Clifford M Takemoto; Allen R Chen; Heather J Symons; David M Loeb; James F Casella; Amy E Dezern; Karen E King; Andrea M McGonigle; Richard J Jones; Robert A Brodsky Journal: J Pediatr Hematol Oncol Date: 2016-11 Impact factor: 1.289