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Decreased incidence of marrow graft rejection in patients with severe
aplastic anemia: changing impact of risk factors
HJ Deeg, S Self, R Storb, K Doney, FR Appelbaum, RP Witherspoon, KM Sullivan, K Sheehan, J Sanders and E Mickelson
Patients with severe aplastic anemia were conditioned with cyclophosphamide
(200 mg/kg) and given marrow grafts from HLA-identical family members.
Among 233 patients transplanted, 225 survived greater than or equal to 14
days and could be evaluated for engraftment. Forty- four of the 225
rejected their graft; 33 of these died and 11 survive. One hundred
eighty-one patients had sustained engraftment; of these, 46 died and 135
survived. Binary logistic regression analyses revealed five risk factors
for graft rejection: year of transplant, a large number of platelet
transfusions, a positive relative response in mixed leukocyte culture, a
low marrow cell dose, and omission of donor buffy coat cell infusion for
transfused patients. These data show that patients transplanted recently
had a lower likelihood of graft rejection than did patients transplanted in
earlier years. Conceivably, this was related to changes in transfusion
practices, but other factors as yet unidentified are likely to be involved.
The data confirm that the largest possible number of marrow cells should be
transplanted. Although the difference in the incidence of graft rejection
between untransfused and transfused patients was not significant, it should
be noted that transfused patients were given buffy coat cells. Because the
addition of buffy coat cells results in a higher incidence of chronic
graft-v-host disease (GVHD), it is still desirable to transplant patients
with marrow alone early in their course before they have been transfused.
Volume 68,
Issue 6,
pp. 1363-1368,
12/01/1986
Copyright © 1986 by The American Society of Hematology
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