Marrow Transplantation in Thirty "Untransfused" Patients with Severe Aplastic Anemia

doi:10.1059/0003-4819-92-1-30

Marrow Transplantation in Thirty "Untransfused" Patients with Severe Aplastic Anemia

Seattle, Washington

Abstract

Thirty patients with severe aplastic anemia had no transfusions of blood products until just before marrow transplantation from HLA-identical family members. They were conditioned for grafting with cyclophosphamide, 50 mg/kg body weight on each of 4 successive days. All 30 had prompt initial marrow engraftment, which was sustained in 27. Twenty-five of the 30 are alive between 9 to 84 (median, 19.5) months. The actuarial projection of survival for 2 to 6 years is 75%. Twenty of the 25 surviving patients have no problems. Five have chronic graft-versus-host disease, resolving in two and active in three. Five patients died with infection or hemorrhage, four of whom had graft-versus-host disease. These data show that early transplantation should be carried out before transfusions are given for any patient with severe aplastic anemia who has an HLA-identical family member. If sensitization to minor transplantation antigens contained in blood products is avoided, the incidence of marrow-graft rejection will decrease, and survival will improve.

Article and Author Information

▸From the Fred Hutchinson Cancer Research Center; and the Departments of Medicine and Pediatrics, Division of Oncology, University of Washington School of Medicine; Seattle, Washington.
Grant Support: CA 18029, CA 15704, CA 09319, and CA 18221, awarded by the National Cancer Institute. Dr. Thomas is a recipient of a Research Career Award AI 02425 from the National Institute of Allergy and Infectious Diseases. Dr. Deeg is a Fellow of the Leukemia Society of America. Dr. Fefer is an American Cancer Society Professor of Clinical Oncology. Dr. Sale is supported in part by a Junior Faculty Clinical Fellowship from the American Cancer Society. Dr. Stewart is supported in part by a Junior Faculty Clinical Fellowship from the American Cancer Society.
▸Requests for reprints should be addressed to Rainer Storb, M.D.; Division of Oncology, Fred Hutchinson Cancer Research Center; 1124 Columbia Street; Seattle, WA 98104.
- Received May 17, 1979.
- Accepted September 18, 1979.