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Blood, Vol. 92 No. 8 (October 15), 1998:
pp. 2742-2749
From the Clinical Research Division, Fred Hutchinson Cancer Research
Center, and the Departments of Medicine and Pediatrics, University of
Washington, Seattle, WA.
Between 1970 and 1996, 333 patients with severe aplastic anemia
underwent HLA-matched related marrow transplant after conditioning with
cyclophosphamide (CY). Thirty-five percent of patients transplanted between 1970 and 1976 (group 1), 12% of those transplanted between 1977 and 1981 (group 2), and 9% of patients transplanted between 1982 and 1997 (group 3) had graft rejection. Graft rejection occurred later
among group 3 patients (median, 180 days) than among those in groups 1 and 2 (medians, 28 and 47 days, respectively; P < .001 group
3 v 2). In group 3, 92% of rejecting patients underwent a
second transplant, compared with 78% and 77% in groups 1 and 2, respectively. Group 1 patients received various conditioning regimens
before second transplant, whereas most patients of groups 2 and 3 received CY combined with antithymocyte globulin (ATG). Graft-versus-host disease (GVHD) prophylaxis after second transplant consisted of methotrexate (MTX) for all group 1 and 2 patients, whereas
group 3 patients received MTX combined with cyclosporine (CSP). Over
the three time periods studied, first graft rejection decreased from
35% to 9%, and the proportion of rejecting patients undergoing second
transplants increased from 77% to 92%. The 10-year probability of
survival after second transplants increased from 5% to 83%.
Multivariate analysis showed MTX/CSP GVHD prophylaxis to be a
significant factor accounting for the increase in patient survival
after second transplant.
© 1998 by The American Society of Hematology.
This article has been cited by other articles:
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