The Latin American experience of allografting patients with severe aplastic anaemia: real-world data on the impact of stem cell source and ATG administration in HLA-identical sibling transplants

• Published in: Bone marrow transplantation (Basingstoke) Vol. 52; no. 1; pp. 41 - 46
• Main Authors: Gómez-Almaguer, D, Vázquez-Mellado, A, Navarro-Cabrera, J R, Abello-Polo, V, Milovic, V, García, J, Basquiera, A L, Saba, S, Balladares, G, Vela-Ojeda, J, Gómez, S, Karduss-Aurueta, A, Bustinza-Álvarez, A, Requejo, A, Feldman, L, Jaime-Pérez, J C, Yantorno, S, Kusminsky, G, Gutiérrez-Aguirre, C H, Arbelbide, J, Martinez-Rolon, J, Jarchum, G, Jaimovich, G, Riera, L, Pedraza-Mesa, E, Villamizar-Gómez, L, Herrera-Rojas, M Á, Gamboa-Alonso, M M, Foncuberta, C, Rodríguez-González, G, García Ruiz-Esparza, M A, Hernández-Maldonado, E, Paz-Infanzón, M, González-López, E, Ruiz-Argüelles, G J
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.01.2017; Nature Publishing Group
• Subjects: 13/100; 631/250/1904; 631/532/1542; 692/699/1541/13; 692/699/249/1529; 692/700/1750/1976; Acute Disease; Adolescent; Adult; Aged; Allografts; Analysis; Anemia, Aplastic - mortality; Anemia, Aplastic - therapy; Antilymphocyte Serum - administration & dosage; Aplastic anemia; Bone marrow; Bone marrow transplantation; Care and treatment; Cell Biology; Child; Child, Preschool; Disease-Free Survival; Female; Graft vs Host Disease - mortality; Graft vs Host Disease - prevention & control; Hematology; HLA Antigens; Homografts; Humans; Internal Medicine; Latin America; Male; Medicine; Medicine & Public Health; Middle Aged; original-article; Public Health; Siblings; Stem Cell Transplantation; Stem Cells; Survival Rate
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2016.212

We studied 298 patients with severe aplastic anaemia (SAA) allografted in four Latin American countries. The source of cells was bone marrow (BM) in 94 patients and PBSCs in 204 patients. Engraftment failed in 8.1% of recipients with no difference between BM and PBSCs ( P =0.08). Incidence of acute GvHD (aGvHD) for BM and PBSCs was 30% vs 32% ( P =0.18), and for grades III–IV was 2.6% vs 11.6% ( P =0.01). Chronic GvHD (cGvHD) between BM and PBSCs was 37% vs 59% ( P =0.002) and extensive 5% vs 23.6% ( P =0.01). OS was 74% vs 76% for BM vs PBSCs ( P =0.95). Event-free survival was superior in patients conditioned with anti-thymocyte globulin (ATG)-based regimens compared with other regimens (79% vs 61%, P =0.001) as excessive secondary graft failure was seen with other regimens (10% vs 26%, P =0.005) respectively. In multivariate analysis, aGvHD II–IV (hazard ratio (HR) 2.50, confidence interval (CI) 1.1–5.6, P =0.02) and aGvHD III–IV (HR 8.3 CI 3.4–20.2, P <0.001) proved to be independent negative predictors of survival. In conclusion, BM as a source of cells and ATG-based regimens should be standard because of higher GvHD incidence with PBSCs, although the latter combining with ATG in the conditioning regimen could be an option in selected high-risk patients.