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Risk factors affecting outcome of second HLA-matched sibling donor transplantations for graft failure in severe acquired aplastic anemia

Horan, John T. and Carreras, Jeanette and Tarima, Sergey and Camitta, Bruce M. and Gale, Robert Peter and Hale, Gregory A. and Hinterberger, Wolfgang and Marsh, Judith and Passweg, Jakob R. and Walters, Mark C. and Eapen, Mary. (2009) Risk factors affecting outcome of second HLA-matched sibling donor transplantations for graft failure in severe acquired aplastic anemia. Biology of blood and marrow transplantation : official journal of the American Society for Blood and Marrow Transplantation, Vol. 15. pp. 626-631.

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Official URL: http://edoc.unibas.ch/dok/A6004072

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Abstract

We examined transplantation outcomes after a second HLA-matched sibling transplantation for primary (16%) or secondary (84%) graft failure in 166 patients with severe acquired aplastic anemia (AA). Two-thirds of these patients has a performance score > 90. In most cases (88%), the same donor was used for both transplants, for both transplantations, and 84% of the second transplantations used bone marrow grafts. We identified 2 prognostic factors: intertransplantation interval (surrogate for primary graft failure and early secondary graft failure) and performance status. Shorter intertransplantation interval (>or= 3 months) and poor performance score (> 90) at second transplantation were associated with high mortality. In patients with a performance score of 90% to 100%, the 8-year probability of overall survival (OS) after second transplantation >or= 3 and < 3 months from first transplantation was 56% and 76%, respectively. The corresponding probabilities in patients with lower performance scores were 33% and 61%. The predominant cause of failure after second transplantation was nonengraftment (in 72 of 166 patients), most commonly in patients with primary or early secondary graft failure (51 of 72; 71%). Our data indicate that novel approaches, including conditioning regimens with greater immunosuppression, should be explored for these patients.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Hämatologie > Hämatologie (Passweg)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Hämatologie > Hämatologie (Passweg)
UniBasel Contributors:Passweg, Jakob R.
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Elsevier
ISSN:1083-8791
Note:Publication type according to Uni Basel Research Database: Journal article
Last Modified:24 May 2013 09:22
Deposited On:24 May 2013 09:04

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