The Latin American experience of allografting patients with severe aplastic anaemia: real-world data on the impact of stem cell source and ATG administration in HLA-identical sibling transplants

Gómez Almaguer, David y Vázquez Mellado, Alberto y Navarro Cabrera, Juan Ramón y Abello Polo, Virginia y Milovic, Vera y García, Juan José y Basquiera, Ana Lisa y Saba, Silvia y Balladares, G. y Vela Ojeda, Jorge y Gómez, S. y Karduss Aurueta, A. y Bustinza Álvarez, Adriana y Requejo, Alejandro y Feldman, Leonardo y Jaime Pérez, José Carlos y Yantorno, Sebastián y Kusminsky, G. y Gutiérrez Aguirre, César Homero y Arbelbide, Jorge Alberto y Martínez Rolon, Juliana y Jarchum, Gustavo y Jaimovich, Gregorio y Riera, L. y Pedraza Mesa, Enrique y Villamizar Gómez, Francy Licet y Herrera Rojas, Miguel Ángel y Gamboa Alonso, M M y Foncuberta, María Cecilia y Rodríguez González, Guadalupe y García Ruiz Esparza, Miriam América y Hernández Maldonado, E. y Paz Infanzón, Manuel y González Lopez, Elias Eugenio y Ruiz Argüelles, Guillermo José (2016) The Latin American experience of allografting patients with severe aplastic anaemia: real-world data on the impact of stem cell source and ATG administration in HLA-identical sibling transplants. Bone marrow transplantation, 52 (1). pp. 41-46. ISSN 0268-3369

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Resumen

We studied 298 patients with severe aplastic anaemia (SAA) allografted in four Latin American countries. The source of cells was bone marrow (BM) in 94 patients and PBSCs in 204 patients. Engraftment failed in 8.1% of recipients with no difference between BM and PBSCs (P = 0.08). Incidence of acute GvHD (aGvHD) for BM and PBSCs was 30% vs 32% (P = 0.18), and for grades III–IV was 2.6% vs 11.6% (P = 0.01). Chronic GvHD (cGvHD) between BM and PBSCs was 37% vs 59% (P = 0.002) and extensive 5% vs 23.6% (P = 0.01). OS was 74% vs 76% for BM vs PBSCs (P = 0.95). Event-free survival was superior in patients conditioned with anti-thymocyte globulin (ATG)-based regimens compared with other regimens (79% vs 61%, P = 0.001) as excessive secondary graft failure was seen with other regimens (10% vs 26%, P = 0.005) respectively. In multivariate analysis, aGvHD II–IV (hazard ratio (HR) 2.50, confidence interval (CI) 1.1–5.6, P = 0.02) and aGvHD III–IV (HR 8.3 CI 3.4–20.2, Po0.001) proved to be independent negative predictors of survival. In conclusion, BM as a source of cells and ATG-based regimens should be standard because of higher GvHD incidence with PBSCs, although the latter combining with ATG in the conditioning regimen could be an option in selected high-risk patients

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