TY - JOUR
T1 - Choice of conditioning regimens for bone marrow transplantation in severe aplastic anemia
AU - Bejanyan, Nelli
AU - Kim, Soyoung
AU - Hebert, Kyle M.
AU - Kekre, Natasha
AU - Abdel-Azim, Hisham
AU - Ahmed, Ibrahim
AU - Aljurf, Mahmoud
AU - Badawy, Sherif M.
AU - Beitinjaneh, Amer
AU - Boelens, Jaap Jan
AU - Diaz, Miguel Angel
AU - Dvorak, Christopher C.
AU - Gadalla, Shahinaz
AU - Gajewski, James
AU - Gale, Robert Peter
AU - Ganguly, Siddhartha
AU - Gennery, Andrew R.
AU - George, Biju
AU - Gergis, Usama
AU - Gómez-Almaguer, David
AU - Vicent, Marta Gonzalez
AU - Hashem, Hasan
AU - Kamble, Rammurti T.
AU - Kasow, Kimberly A.
AU - Lazarus, Hillard M.
AU - Mathews, Vikram
AU - Orchard, Paul J.
AU - Pulsipher, Michael
AU - Ringden, Olle
AU - Schultz, Kirk
AU - Teira, Pierre
AU - Woolfrey, Ann E.
AU - Saldaña, Blachy Dávila
AU - Savani, Bipin
AU - Winiarski, Jacek
AU - Yared, Jean
AU - Weisdorf, Daniel J.
AU - Antin, Joseph H.
AU - Eapen, Mary
N1 - Publisher Copyright:
© 2019 American Society of Hematology. All rights reserved.
PY - 2019
Y1 - 2019
N2 - Allogeneic bone marrow transplantation (BMT) is curative therapy for the treatment of patients with severe aplastic anemia (SAA). However, several conditioning regimens can be used for BMT. We evaluated transplant conditioning regimens for BMT in SAA after HLA-matched sibling and unrelated donor BMT. For recipients of HLA-matched sibling donor transplantation (n 5 955), fludarabine (Flu)/cyclophosphamide (Cy)/antithymocyte globulin (ATG) or Cy/ATG led to the best survival. The 5-year probabilities of survival with Flu/Cy/ATG, Cy/ATG, Cy 6 Flu, and busulfan/Cy were 91%, 91%, 80%, and 84%, respectively (P 5 .001). For recipients of 8/8 and 7/8 HLA allele-matched unrelated donor transplantation (n 5 409), there were no differences in survival between regimens. The 5-year probabilities of survival with Cy/ATG/total body irradiation 200 cGy, Flu/Cy/ATG/total body irradiation 200 cGy, Flu/Cy/ATG, and Cy/ATG were 77%, 80%, 75%, and 72%, respectively (P 5 .61). Rabbit-derived ATG compared with equine-derived ATG was associated with a lower risk of grade II to IV acute graft-versus-host disease (GVHD) (hazard ratio [HR], 0.39; P, .001) but not chronic GVHD. Independent of conditioning regimen, survival was lower in patients aged .30 years after HLA-matched sibling (HR, 2.74; P, .001) or unrelated donor (HR, 1.98; P 5 .001) transplantation. These data support Flu/Cy/ATG and Cy/ATG as optimal regimens for HLA-matched sibling BMT. Although survival after an unrelated donor BMT did not differ between regimens, use of rabbit-derived ATG may be preferred because of lower risks of acute GVHD.
AB - Allogeneic bone marrow transplantation (BMT) is curative therapy for the treatment of patients with severe aplastic anemia (SAA). However, several conditioning regimens can be used for BMT. We evaluated transplant conditioning regimens for BMT in SAA after HLA-matched sibling and unrelated donor BMT. For recipients of HLA-matched sibling donor transplantation (n 5 955), fludarabine (Flu)/cyclophosphamide (Cy)/antithymocyte globulin (ATG) or Cy/ATG led to the best survival. The 5-year probabilities of survival with Flu/Cy/ATG, Cy/ATG, Cy 6 Flu, and busulfan/Cy were 91%, 91%, 80%, and 84%, respectively (P 5 .001). For recipients of 8/8 and 7/8 HLA allele-matched unrelated donor transplantation (n 5 409), there were no differences in survival between regimens. The 5-year probabilities of survival with Cy/ATG/total body irradiation 200 cGy, Flu/Cy/ATG/total body irradiation 200 cGy, Flu/Cy/ATG, and Cy/ATG were 77%, 80%, 75%, and 72%, respectively (P 5 .61). Rabbit-derived ATG compared with equine-derived ATG was associated with a lower risk of grade II to IV acute graft-versus-host disease (GVHD) (hazard ratio [HR], 0.39; P, .001) but not chronic GVHD. Independent of conditioning regimen, survival was lower in patients aged .30 years after HLA-matched sibling (HR, 2.74; P, .001) or unrelated donor (HR, 1.98; P 5 .001) transplantation. These data support Flu/Cy/ATG and Cy/ATG as optimal regimens for HLA-matched sibling BMT. Although survival after an unrelated donor BMT did not differ between regimens, use of rabbit-derived ATG may be preferred because of lower risks of acute GVHD.
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U2 - 10.1182/bloodadvances.2019000722
DO - 10.1182/bloodadvances.2019000722
M3 - Article
C2 - 31648332
AN - SCOPUS:85075150491
SN - 2473-9529
VL - 3
SP - 3123
EP - 3131
JO - Blood Advances
JF - Blood Advances
IS - 20
ER -