Allogeneic bone marrow transplantation for severe aplastic anemia: the Vancouver experience

R.J.G. Cuthbert
J.D. Shepherd
S.H. Nantel
M.J. Barnett
D.E. Reece
H.-G. Klingemann
K.W. Chan
J.J. Spinelli
H.J. Sutherland
G.L. Phillips

Leukemia/Bone Marrow Transplantation Program of British Columbia: Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency and the University of British Columbia, and B.C. Children's Hospital, Vancouver, British Columbia

(Original manuscript submitted 10/5/94; received in revised form 28/9/94; accepted 30/9/94)

Abstract

We report a retrospective analysis of the experience of a single centre in treating severe aplastic anemia (SAA) with allogeneic bone marrow transplant (BMT). Between 1982 and 1992, we transplanted 21 patients with SAA (14 males, 7 females); median age at BMT was 15 y (range 2-40 y); median time from diagnosis of SAA to BMT was 29 d (range 6 d to 5.5 y). Thirteen patients had received multiple transfusions before BMT. Patients were conditioned with cyclophosphamide 50 mg/kg for 4 d, ą total body irradiation 300-500 cGy as a single fraction; 1 patient received total nodal irradiation (750 cGy) plus antithymocyte globulin. Sixteen patients received bone marrow from human leucocyte antigen (HLA)-identical siblings, 3 from haplo-identical parents, and 2 from unrelated volunteer donors; graft-versus-host disease (GVHD) prophylaxis was variable. Three patients failed to fully engraft following BMT; 2 achieved successful engraftment following a second BMT. Six of 20 evaluable patients (30%) developed grade II-IV acute GVHD, of whom 3 died; 3 patients developed limited and 5 patients (31%) developed extensive chronic GVHD, of whom 1 died. Fourteen patients (67%) are alive and well following BMT with a median follow-up of 6 y (range 2.1-11 y). Survival was superior in patients receiving sibling-donor BMT (75%) compared with those receiving parent- or unrelated-donor BMT (40%). We conclude that allogencic BMT remains an important mode of treatment for SAA, but long-term survival remains limited by graft failure and GVHD.

Clin Invest Med 1995; 18 (2): 122-130

Table of contents: CIM vol. 18, no. 2