PMID- 12621487
OWN - NLM
STAT- MEDLINE
DCOM- 20030923
LR  - 20131121
IS  - 0268-3369 (Print)
IS  - 0268-3369 (Linking)
VI  - 31
IP  - 2
DP  - 2003 Jan
TI  - Successful allogeneic hematopoietic stem cell transplantation using triple agent 
      immunosuppression in severe aplastic anemia patients.
PG  - 79-86
AB  - Graft rejection in patients with severe aplastic anemia (SAA) following 
      allogeneic hematopoietic stem cell transplantation (HSCT) is strongly associated 
      with a large number of prior transfusions and with prolonged disease duration 
      before transplant. We retrospectively analyzed the outcomes and the factor 
      affecting these multitransfused SAA patients, who had received triple agent 
      immunosuppression and high doses of stem cells to overcome rejection. In total, 
      113 patients with SAA who had a median 16 months (range 1-216) of disease 
      duration were transplanted using HLA-matched sibling donors after conditioning 
      with cyclophosphamide (CY), procarbazine (PCB), and ATG. Graft failure occurred 
      in 16 of the eligible 113 patients, and with a median follow-up of 30 months 
      (range, 1-80), probability of overall rejection was 15%. Specifically, the 
      multitransfused patients who received high doses of stem cells with T-cell 
      depletion showed the lowest rejection rate, 5.6%, compared with 30.3% in 
      multitransfused patients with bone marrow stem cells alone (P=0.0310). Disease 
      duration (P=0.0338) and the number of infused CD34+cells (P=0.0101) were 
      associated with a high risk of graft rejection on multivariate analysis. ABO 
      mismatch and the number of CD34+ cells were significant factors in the incidence 
      of acute graft-versus-host-disease (GVHD). The incidence of chronic GVHD among 
      patients with sustained engraftment was 13/109 (11.9%). With the same follow-up 
      period, probability of disease-free survival for the entire group of patients at 
      6 years was 89% and the only factor associated with long-term survival was 
      rejection (P=0.0241). These results suggest that allogeneic HSCT conditioned with 
      triple agent immunosuppression, and specifically with high-dose stem cell return 
      is probably an effective treatment for successful engraftment in SAA patients 
      with a high risk of rejection.
FAU - Kim, H J
AU  - Kim HJ
AD  - Catholic Hemopoeitic Stem Cell Transplantation Center, The Catholic University of 
      Korea, Seoul, Korea.
FAU - Park, C Y
AU  - Park CY
FAU - Park, Y H
AU  - Park YH
FAU - Kim, Y J
AU  - Kim YJ
FAU - Kim, D W
AU  - Kim DW
FAU - Min, W S
AU  - Min WS
FAU - Kim, C C
AU  - Kim CC
LA  - eng
PT  - Journal Article
PL  - England
TA  - Bone Marrow Transplant
JT  - Bone marrow transplantation
JID - 8702459
RN  - 0 (ABO Blood-Group System)
RN  - 0 (Antilymphocyte Serum)
RN  - 0 (Immunosuppressive Agents)
RN  - 8N3DW7272P (Cyclophosphamide)
SB  - IM
MH  - ABO Blood-Group System
MH  - Adolescent
MH  - Adult
MH  - Anemia, Aplastic/*therapy
MH  - Antilymphocyte Serum/therapeutic use
MH  - Blood Transfusion
MH  - Cyclophosphamide/therapeutic use
MH  - Disease-Free Survival
MH  - Drug Therapy, Combination
MH  - Female
MH  - Graft Rejection/epidemiology
MH  - Graft vs Host Disease/epidemiology
MH  - Histocompatibility Testing
MH  - Humans
MH  - Immunosuppressive Agents/*therapeutic use
MH  - Living Donors
MH  - Male
MH  - Middle Aged
MH  - Probability
MH  - Retrospective Studies
MH  - Siblings
MH  - *Stem Cell Transplantation/adverse effects/mortality
MH  - Survival Analysis
MH  - Time Factors
MH  - Transplantation, Homologous/adverse effects/*immunology/mortality
MH  - Treatment Outcome
EDAT- 2003/03/07 04:00
MHDA- 2003/09/25 05:00
CRDT- 2003/03/07 04:00
PHST- 2003/03/07 04:00 [pubmed]
PHST- 2003/09/25 05:00 [medline]
PHST- 2003/03/07 04:00 [entrez]
AID - 1703786 [pii]
AID - 10.1038/sj.bmt.1703786 [doi]
PST - ppublish
SO  - Bone Marrow Transplant. 2003 Jan;31(2):79-86. doi: 10.1038/sj.bmt.1703786.