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Unrelated alternative donor transplantation for severe acquired aplastic anemia: a study from the French Society of Bone Marrow Transplantation and Cell Therapies and the EBMT Severe Aplastic Anemia Working Party.

Devillier, R; Dalle, J-H; Kulasekararaj, A; D'aveni, M; Clément, L; Chybicka, A; Vigouroux, S; Chevallier, P; Koh, M; Bertrand, Y; et al. Devillier, R; Dalle, J-H; Kulasekararaj, A; D'aveni, M; Clément, L; Chybicka, A; Vigouroux, S; Chevallier, P; Koh, M; Bertrand, Y; Michallet, M; Zecca, M; Yakoub-Agha, I; Cahn, J-Y; Ljungman, P; Bernard, M; Loiseau, P; Dubois, V; Maury, S; Socié, G; Dufour, C; Peffault de Latour, R (2016) Unrelated alternative donor transplantation for severe acquired aplastic anemia: a study from the French Society of Bone Marrow Transplantation and Cell Therapies and the EBMT Severe Aplastic Anemia Working Party. Haematologica, 101 (7). pp. 884-890. ISSN 1592-8721 https://doi.org/10.3324/haematol.2015.138727
SGUL Authors: Koh, Mickey

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Abstract

Unrelated allogeneic transplantation for severe aplastic anemia is a treatment option after immunosuppressive treatment failure in the absence of a matched sibling donor. Age, delay between disease diagnosis and transplantation, and HLA matching are the key factors in transplantation decisions, but their combined impact on patient outcomes remains unclear. Using the French Society of Bone Marrow Transplantation and Cell Therapies registry, we analyzed all consecutive patients (n=139) who underwent a first allogeneic transplantation for idiopathic severe aplastic anemia from an unrelated donor between 2000 and 2012. In an adjusted multivariate model, age over 30 years (Hazard Ratio=2.39; P=0.011), time from diagnosis to transplantation over 12 months (Hazard Ratio=2.18; P=0.027) and the use of a 9/10 mismatched unrelated donor (Hazard Ratio=2.14; P=0.036) were independent risk factors that significantly worsened overall survival. Accordingly, we built a predictive score using these three parameters, considering patients at low (zero or one risk factors, n=94) or high (two or three risk factors, n=45) risk. High-risk patients had significantly shorter survival (Hazard Ratio=3.04; P<0.001). The score was then confirmed on an independent cohort from the European Group for Blood and Marrow Transplantation database of 296 patients, with shorter survival in patients with at least 2 risk factors (Hazard Ratio=2.13; P=0.005) In conclusion, a simple score using age, transplantation timing and HLA matching would appear useful to help physicians in the daily care of patients with severe aplastic anemia.

Item Type: Article
Additional Information: ©2016 Ferrata Storti Foundation Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/101/7/884 Material published in Haematologica is covered by copyright. All rights are reserved to the Ferrata Storti Foundation. Copies of articles are allowed for personal or internal us. Permission in writing from the publisher is required for any other use.
Keywords: Immunology, 1102 Cardiovascular Medicine And Haematology
SGUL Research Institute / Research Centre: Academic Structure > Institute of Medical & Biomedical Education (IMBE)
Academic Structure > Institute of Medical & Biomedical Education (IMBE) > Centre for Clinical Education (INMECE )
Journal or Publication Title: Haematologica
ISSN: 1592-8721
Language: eng
Dates:
DateEvent
1 July 2016Published
7 April 2016Published Online
5 April 2016Accepted
Publisher License: Publisher's own licence
PubMed ID: 27056924
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/108176
Publisher's version: https://doi.org/10.3324/haematol.2015.138727

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