Outcome Of Hematopoietic Cell Transplantation From Siblings For41Severe Aplastic Anemia

Objegtive To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation from HLA-matched siblings (MSD allo-HSCT) for severe aplastic anemia (SAA).Methods Retrospective analysis the clinical data of41SAA patients received MSD allo-HSCT from2003.5to2011.8.31,28patients suffered from SAA-I,9patients suffered from SAA-II,4patients suffered from aplastic anemia post-hepatitis, median age is23(5-43) years old,17patients conducted allogeneic bone marrow transplantation (allo-BMT),24patients conducted allogeneic peripheral blood stem cell transplantation (allo-PBSCT),20patients’conditioning regimen was CY+ATG+Flu,21patients’ conditioning regimen was CY+ATG+Flu±Bu/Mel,25paitents’GVHD preventing regimen was CSA+MTX,16paitents’GVHD preventing regimen was FK506+MTX, the median reinfusion quantity of CD34+was3.48(2.39-4.8) X106/kg in allo-BMT and2.95(1.27-5.98)×105/kg in allo-PBSCT.Resuits Hematopoiesis reconstitution was achieved in all41patients (100%). The median time of neutrophils reached to0.5×109/L and platelets reached to20×108/L were14(10-23) days and19(8-38) days, respectively.12patients developed acute graft-versus-host diseaes(aGVHD), all out of them,11patients developed grade Ⅰ-Ⅱ aGVHD, one patient developed grade IV aGVHD, two patients occurred chronic GVHD(cGVHD),one with local cGVHD and the other one with widely cGVHD. Graft rejection(GR) was occurred in4patients, all4patients recovery haemopoietic and survival with donor peripheral blood stem cell infusion.5patients died (18.9%±9.0%), one patient died of widely cGVHD,4patients died of invasive fungal infections. Median follow-up time was23(3-79) months.36patients survive, and prospective OS, DFS for5years and TRM is81.1%±9.0%,68.4%±11%,18.9%±9.0%, respectively. Univariate analysis showed that five factors can reduce OS, including conducted PBSCT, occurrence of aGVHD, infusion quantity of CD34+cells no more than2.5×106/kg, the number of blood transfusion befor transplantation more than30u and occurrence of invasive fungal infections after transplantation (P=0.034,0.001,0.006,0.000,0.001); four factors were related with occurrence of aGVHD, including the difference of donor and recipient’s ABO blood group, the number of platelet transfusion befor transplantation more than100u, the number of blood transfusion befor transplantation more than30u,infusion quantity of CD34+no more than2.5×106/kg(P=0.019,0.038,0.005,0.005); the number of platelet transfusion befor transplantation more than100u was related with occurrance of GR (P=0.038)Conclusion MSD allo-HSCT is an effective therapy for patients with SAA. Reducing the number of blood transfusion befor transplantation, using bone marrow transplantation, increasing infusion quantity of CD34+cells, effective prevention and treatment of aGVHD and invasive fungal infections after transplantation may improve the efficacy of MSD allo-HSCT for SAA.