Current Outcome of HLA Identical Sibling vs Unrelated Donor Transplants in Severe Aplastic Anemia: An EBMT Analysis | Aplastic Anemia and MDS International Foundation

Current Outcome of HLA Identical Sibling vs Unrelated Donor Transplants in Severe Aplastic Anemia: An EBMT Analysis

Original Publication Date: 
Monday, February 10, 2014

Note: This review is based upon a presentation at the 2013 American Society of Hematology (ASH) Annual Meeting, December 7-10 in New Orleans, Louisiana.The full abstract may be reviewed on the ASH Annual Meeting Web site. Search by entering the title in the search box. The abstract number is referenced to access the full report.

Abstract # 707

Andrea Bacigalupo, M.D., Gérard Socié, M.D., Ph.D., Rose-Marie Hamljadi, Mahmoud Aljurf, A. Mashan, Slawomira Kyrcz-Krzemien, M.D., A. Cybicka, H. Sengeloev, Ali Unal, M.D., Dietrich Beelen, M.D., A Locasciulli, Carlo Dufour, M.D., Jakob R. Passweg, R. Oneto, and Judith Marsh

Hematopoietic stem cell transplantation (HSCT) for severe aplastic anemia involves the infusion of healthy blood-forming (hematopoietic) stem cells. Ideally, the healthy stem cells come from a sibling who has the same HLA (immune system) markers as the patient. HSCT from an HLA-matched, unrelated donor appears to have poorer outcomes than from a matched sibling donor.

A group of researchers from throughout Europe compared the outcomes of HSCT from unrelated donors and siblings. The study included 1,500 patients in the European Group for Blood and Marrow Transplantation Aplastic Anemia Registry. All patients had severe aplastic anemia and had received an HLA-matched transplant between 2005 and 2009. Of these 1,500 patients, 975 received a transplant from a sibling and 525 from an unrelated donor.

Key findings:

  • Donor stem cells (known as grafts) formed healthy blood cells in the bone marrow of 91% of patients in both groups.
  • Rates of graft-versus-host disease, a common complication of HSCT, were 11% in the sibling donor group and 25% in the unrelated donor group.
  • The 5-year survival rates were 91% in the sibling donor and 81% in the unrelated donor groups for the 541 low-risk patients, 74% versus 72% for the 829 intermediate-risk patients, and 53% versus 50% for the 130 high-risk patients.

Conclusions:

  • The outcomes of HSCT from matched sibling and unrelated donors in patients with severe aplastic anemia were similar.
  • HSCT from HLA-matched, unrelated donors might be appropriate for patients with severe aplastic anemia who do not have an HLA-matched sibling and are younger than 60.
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