Effect of stem cell source on outcomes after unrelated donor transplantation in severe aplastic anemia

TY - JOUR

T1 - Effect of stem cell source on outcomes after unrelated donor transplantation in severe aplastic anemia

AU - Eapen, Mary

AU - Le Rademacher, Jennifer

AU - Antin, Joseph H.

AU - Champlin, Richard E.

AU - Carreras, Jeanette

AU - Fay, Joseph

AU - Passweg, Jakob R.

AU - Tolar, Jakub

AU - Horowitz, Mary M.

AU - Marsh, Judith C. W.

AU - Deeg, H. Joachim

PY - 2011/9/1

Y1 - 2011/9/1

N2 - Outcome after unrelated donor bone marrow (BM) transplantation for severe aplastic anemia (SAA) has improved, with survival rates now approximately 75%. Increasing use of peripheral blood stem and progenitor cells (PBPCs) instead of BM as a graft source prompted us to compare outcomes of PBPC and BM transplantation for SAA. We studied 296 patients receiving either BM (n = 225) or PBPC (n = 71) from unrelated donors matched at human leukocyte antigen-A, -B, -C, -DRB1. Hematopoietic recovery was similar after PBPC and BM transplantation. Grade 2 to 4 acute graft-versus-host disease risks were higher after transplantation of PBPC compared with BM (hazard ratio = 1.68, P = .02; 48% vs 31%). Chronic graft-versus-host disease risks were not significantly different after adjusting for age at transplantation (hazard ratio = 1.39, P = .14). Mortality risks, independent of age, were higher after PBPC compared with BM transplantation (hazard ratio = 1.62, P = .04; 76% vs 61%). These data indicate that BM is the preferred graft source for unrelated donor transplantation in SAA.

AB - Outcome after unrelated donor bone marrow (BM) transplantation for severe aplastic anemia (SAA) has improved, with survival rates now approximately 75%. Increasing use of peripheral blood stem and progenitor cells (PBPCs) instead of BM as a graft source prompted us to compare outcomes of PBPC and BM transplantation for SAA. We studied 296 patients receiving either BM (n = 225) or PBPC (n = 71) from unrelated donors matched at human leukocyte antigen-A, -B, -C, -DRB1. Hematopoietic recovery was similar after PBPC and BM transplantation. Grade 2 to 4 acute graft-versus-host disease risks were higher after transplantation of PBPC compared with BM (hazard ratio = 1.68, P = .02; 48% vs 31%). Chronic graft-versus-host disease risks were not significantly different after adjusting for age at transplantation (hazard ratio = 1.39, P = .14). Mortality risks, independent of age, were higher after PBPC compared with BM transplantation (hazard ratio = 1.62, P = .04; 76% vs 61%). These data indicate that BM is the preferred graft source for unrelated donor transplantation in SAA.

KW - MARROW TRANSPLANTATION

KW - PATHOPHYSIOLOGY

KW - GVHD

U2 - 10.1182/blood-2011-05-354001

DO - 10.1182/blood-2011-05-354001

M3 - Article

SN - 0006-4971

VL - 118

SP - 2618

EP - 2621

JO - Blood

JF - Blood

IS - 9

ER -