en
Scientific article
English

Risk factors affecting outcome of second HLA-matched sibling donor transplantations for graft failure in severe acquired aplastic anemia

Published inBiology of blood and marrow transplantation, vol. 15, no. 5, p. 626-631
Publication date2009
Abstract

We examined transplantation outcomes after a second HLA-matched sibling transplantation for primary (16%) or secondary (84%) graft failure in 166 patients with severe acquired aplastic anemia (AA). Two-thirds of these patients has a performance score < 90. In most cases (88%), the same donor was used for both transplants, for both transplantations, and 84% of the second transplantations used bone marrow grafts. We identified 2 prognostic factors: intertransplantation interval (surrogate for primary graft failure and early secondary graft failure) and performance status. Shorter intertransplantation interval ( ≤ 3 months) and poor performance score (< 90) at second transplantation were associated with high mortality. In patients with a performance score of 90% to 100%, the 8-year probability of overall survival (OS) after second transplantation ≤ 3 and > 3 months from first transplantation was 56% and 76%, respectively. The corresponding probabilities in patients with lower performance scores were 33% and 61%. The predominant cause of failure after second transplantation was nonengraftment (in 72 of 166 patients), most commonly in patients with primary or early secondary graft failure (51 of 72; 71%). Our data indicate that novel approaches, including conditioning regimens with greater immunosuppression, should be explored for these patients.

Keywords
  • Adolescent
  • Adult
  • Anemia, Aplastic/*surgery
  • Bone Marrow Transplantation/*methods
  • Child
  • Female
  • Graft Rejection/*diagnosis
  • Hematopoiesis
  • Histocompatibility Testing
  • Humans
  • Male
  • Prognosis
  • Reoperation
  • Risk Factors
  • Siblings
  • Tissue Donors
  • Treatment Outcome
  • Young Adult
Citation (ISO format)
HORAN, John T. et al. Risk factors affecting outcome of second HLA-matched sibling donor transplantations for graft failure in severe acquired aplastic anemia. In: Biology of blood and marrow transplantation, 2009, vol. 15, n° 5, p. 626–631. doi: 10.1016/j.bbmt.2009.01.023
Main files (1)
Article
accessLevelRestricted
Identifiers
ISSN of the journal1083-8791
512views
0downloads

Technical informations

Creation04/23/2012 1:23:48 PM
First validation04/23/2012 1:23:48 PM
Update time03/14/2023 5:25:24 PM
Status update03/14/2023 5:25:24 PM
Last indexation02/12/2024 7:59:38 PM
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack