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Haematologica. 2016 Jul;101(7):884-90. doi: 10.3324/haematol.2015.138727. Epub 2016 Apr 7.

Unrelated alternative donor transplantation for severe acquired aplastic anemia: a study from the French Society of Bone Marrow Transplantation and Cell Therapies and the EBMT Severe Aplastic Anemia Working Party.

Author information

1
Hematology Department, Institut Paoli Calmettes, Marseille, France.
2
Pediatric Hematology Unit, Robert Debré University Hospital, Paris, France.
3
Hematology Department, King's College Hospital, London, UK.
4
Pediatric Hematology Unit, University Hospital, Nancy, France.
5
Pediatric Hematology Unit, University Hospital, Nancy, France Hematology Department, Haut-Leveque Hospital and Bordeaux University Hospital, Pessac, France.
6
Hematology Department, Wroclaw Medical University, Poland.
7
Hematology Department, Haut-Leveque Hospital and Bordeaux University Hospital, Pessac, France.
8
Hematology Department, University Hospital, Nantes, France.
9
Hematology Department, St. George's Hospital, London, UK.
10
Pediatric Hematology Unit, University Hospital, Lyon, France.
11
Hematology Department, University Hospital, Lyon, France.
12
Hematology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
13
Hematology Department, University Hospital, Lille, France.
14
Hematology Department, University Hospital, Grenoble, France.
15
Hematology Department, Karolinska University Hospital, Stockholm, Sweden.
16
Hematology Department, University Hospital, Rennes, France.
17
HLA Laboratory, Saint-Louis University Hospital, Paris, France French Society of Histocompatibility and Immunogenetics (SFHI), France.
18
HLA Laboratory, Etablissement Français du Sang, Lyon, France.
19
Hematology Department, Henri Mondor Hospital, Créteil, France.
20
BMT Department, Saint-Louis Hospital, Diderot Paris 7 University, Paris, France.
21
Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy.
22
BMT Department, Saint-Louis Hospital, Diderot Paris 7 University, Paris, France regis.peffaultdelatour@aphp.fr.

Abstract

Unrelated allogeneic transplantation for severe aplastic anemia is a treatment option after immunosuppressive treatment failure in the absence of a matched sibling donor. Age, delay between disease diagnosis and transplantation, and HLA matching are the key factors in transplantation decisions, but their combined impact on patient outcomes remains unclear. Using the French Society of Bone Marrow Transplantation and Cell Therapies registry, we analyzed all consecutive patients (n=139) who underwent a first allogeneic transplantation for idiopathic severe aplastic anemia from an unrelated donor between 2000 and 2012. In an adjusted multivariate model, age over 30 years (Hazard Ratio=2.39; P=0.011), time from diagnosis to transplantation over 12 months (Hazard Ratio=2.18; P=0.027) and the use of a 9/10 mismatched unrelated donor (Hazard Ratio=2.14; P=0.036) were independent risk factors that significantly worsened overall survival. Accordingly, we built a predictive score using these three parameters, considering patients at low (zero or one risk factors, n=94) or high (two or three risk factors, n=45) risk. High-risk patients had significantly shorter survival (Hazard Ratio=3.04; P<0.001). The score was then confirmed on an independent cohort from the European Group for Blood and Marrow Transplantation database of 296 patients, with shorter survival in patients with at least 2 risk factors (Hazard Ratio=2.13; P=0.005) In conclusion, a simple score using age, transplantation timing and HLA matching would appear useful to help physicians in the daily care of patients with severe aplastic anemia.

PMID:
27056924
PMCID:
PMC5004469
DOI:
10.3324/haematol.2015.138727
[Indexed for MEDLINE]
Free PMC Article

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