PMID- 10465104
OWN - NLM
STAT- MEDLINE
DCOM- 19991008
LR  - 20191103
IS  - 1083-8791 (Print)
IS  - 1083-8791 (Linking)
VI  - 5
IP  - 4
DP  - 1999
TI  - Marrow transplantation from unrelated donors for patients with severe aplastic 
      anemia who have failed immunosuppressive therapy.
PG  - 243-52
AB  - Allogeneic marrow transplantation offers curative therapy for patients with 
      aplastic anemia. We analyzed retrospective results in 141 patients with severe 
      aplastic anemia who received transplants between 1988 and 1995 from an unrelated 
      volunteer donor identified through the National Marrow Donor Program (NMDP). All 
      patients had failed one or more courses of immunosuppressive therapy. Of the 
      patients, 121 (86%) received a radiation-containing conditioning regimen, and 20 
      (14%) were given chemotherapy only. Based on serologic human leukocyte antigen 
      (HLA) typing (class I and II), 105 patients (74%) received HLA-matched marrow, 
      and 36 (26%) received marrow mismatched for at least one HLA-A, -B, or -DR 
      antigen. Allele-level (molecular) typing for HLA-DRB1 was available in 108 
      donor-recipient pairs; 77 patients received DRB -matched and 31 DRB1-mismatched 
      transplants. All but 13% of patients were given a cyclosporine-containing regimen 
      for graft-vs.-host disease (GVHD) prophylaxis, and 45 patients (32%) received 
      marrow that was T cell-depleted. Among 131 evaluable patients, 116 (89%) achieved 
      sustained engraftment and 15 (11%) did not. Among patients with engraftment, 
      acute GVHD of grades II-IV developed in 60 patients (52%) and extensive chronic 
      GVHD in 24 patients at risk (31%). Currently, 51 patients (36%) are surviving at 
      11-94 months (median 36) after transplantation. All but five have Karnofsky 
      scores > or =80. Patients who received a serologically matched transplant fared 
      somewhat better than did patients given a serologically mismatched transplant p = 
      0.03). Patients with donors matched by both serology and allele-level DRB1 typing 
      had significantly better survival than DRB1-mismatched patients with 56 vs. 15% 
      surviving at 3 years p = 0.001). Outcome in patients transplanted within 3 years 
      of diagnosis was superior to that among patients transplanted with greater delay. 
      Major causes of death were graft failure, GVHD, and infections. These data 
      suggest that unrelated marrow transplantation offers successful therapy for a 
      proportion of patients who have failed immunosuppressive therapy.
FAU - Deeg, H J
AU  - Deeg HJ
AD  - Fred Hutchinson Cancer Research Center, the Department of Medicine, University of 
      Washington, Seattle, USA.
FAU - Seidel, K
AU  - Seidel K
FAU - Casper, J
AU  - Casper J
FAU - Anasetti, C
AU  - Anasetti C
FAU - Davies, S
AU  - Davies S
FAU - Gajeweski, J L
AU  - Gajeweski JL
FAU - Territo, M
AU  - Territo M
FAU - Ramsay, N
AU  - Ramsay N
FAU - Harris, R E
AU  - Harris RE
FAU - Catro-Malaspina, H
AU  - Catro-Malaspina H
FAU - Collins, R
AU  - Collins R
FAU - Champlin, R
AU  - Champlin R
FAU - Schoch, G
AU  - Schoch G
FAU - King, R
AU  - King R
FAU - Howe, C
AU  - Howe C
LA  - eng
GR  - HL36444/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Biol Blood Marrow Transplant
JT  - Biology of blood and marrow transplantation : journal of the American Society for 
      Blood and Marrow Transplantation
JID - 9600628
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Anemia, Aplastic/drug therapy/mortality/*therapy
MH  - *Bone Marrow Transplantation/mortality
MH  - Child
MH  - Female
MH  - Graft Survival
MH  - Graft vs Host Disease
MH  - Humans
MH  - Immunophenotyping/methods
MH  - Immunosuppressive Agents/therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Regression Analysis
MH  - Survival Rate
MH  - Tissue Donors
MH  - Transplantation, Homologous/methods/mortality
MH  - Treatment Outcome
EDAT- 1999/08/28 00:00
MHDA- 1999/08/28 00:01
CRDT- 1999/08/28 00:00
PHST- 1999/08/28 00:00 [pubmed]
PHST- 1999/08/28 00:01 [medline]
PHST- 1999/08/28 00:00 [entrez]
AID - S1083879199500141 [pii]
AID - 10.1053/bbmt.1999.v5.pm10465104 [doi]
PST - ppublish
SO  - Biol Blood Marrow Transplant. 1999;5(4):243-52. doi: 
      10.1053/bbmt.1999.v5.pm10465104.