With the COVID-19 pandemic and the ensuing barriers to the collection and transport of donor cells, it is often necessary to collect and cryopreserve grafts before initiation of transplantation conditioning. The effect on transplantation outcomes in nonmalignant disease is unknown. This analysis examined the effect of cryopreservation of related and unrelated donor grafts for transplantation for severe aplastic anemia in the United States during 2013 to 2019. Included are 52 recipients of cryopreserved grafts who were matched for age, donor type, and graft type to 194 recipients who received noncryopreserved grafts. Marginal Cox regression models were built to study the effect of cryopreservation and other risk factors associated with outcomes. We recorded higher 1-year rates of graft failure (hazard ratio [HR], 2.26; 95% confidence interval, 1.17 to 4.35; P = .01) and of 1-year overall mortality (HR, 3.13; 95% CI, 1.60 to 6.11; P = .0008) after transplantation of cryopreserved compared with noncryopreserved grafts, with adjustment for sex, performance score, comorbidity, cytomegalovirus serostatus, and ABO blood group match. The incidence of acute and chronic graft-versus-host disease did not differ between the 2 groups. Adjusted probabilities of 1-year survival were 73% (95% CI, 60% to 84%) in the cryopreserved graft group and 91% (95% CI, 86% to 94%) in the noncryopreserved graft group. These data support the use of noncryopreserved grafts whenever possible in patients with severe aplastic anemia.
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Financial disclosure: The Center for International Blood and Marrow Transplant Research is supported primarily by Public Health Service Grant/Cooperative Agreement 5U24-CA076518 from the National Cancer Institute, the National Heart, Lung and Blood Institute, and the National Institute of Allergy and Infectious Diseases; Contract HHSH250201200016C with the Health Resources and Services Administration (HRSA); and Grants N00014-15-1-0848 and N00014-16-1-2020 from the Office of Naval Research. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, Department of the Navy, Department of Defense, HRSA, or any other agency of the US Government.
Conflict of interest statement: M.H. has received research support from Takeda Pharmaceutical, Otsuka Pharmaceutical, Spectrum Pharmaceuticals, and Astellas Pharma; has served as a consultant for Incyte, ADC Therapeutics, Celgene, Pharmacyclics, Magenta Therapeutics, Omeros, AbGenomics, Verastem, and TeneoBio; and has served on the speakers bureau for Sanofi Genzyme and AstraZeneca. A.D. has received research support from Takeda Pharmaceutical, Sanofi Genzyme, AstraZeneca, TeneoBio, Prothena, EDO, and Mundipharma and has received consulting fees from Prothena, Pfizer, Akcea, Imbrium, and Janssen. The other authors have no conflicts of interest to report.
© 2020 American Society for Transplantation and Cellular Therapy
- Cryopreserved graft
- Severe aplastic anemia