medigraphic.com
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2005, Number 2

<< Back Next >>

Rev Invest Clin 2005; 57 (2)

Hematopoietic stem-cell transplantation in aplastic anemia

Hernández-Rivera EG

Language: Spanish
References: 25
Page: 298-304
PDF size: 62.08 Kb.


ABSTRACT

Severe aplastic anemia is a rare syndrome characterized by bone marrow failure with cytopenias and hypocellular bone marrow biopsy (usually 10-15%), without blasts or myelodysplasia. The first choice treatment for these patients is allogeneic bone marrow transplantation from a sibling matched for HLA-A, HLA-B y HLA-DR. Unfortunately only 30% of patients have an HLA-matched sibling (a 25% chance per sibling). The alternative treatment for severe aplastic anemia for the rest of the patients (70%) is immunosuppression with antithymocyte globuline and cyclosporine. The evolution of bone marrow transplantation since 1970’s has been positive in terms of survival and transplant success (initial overall survival 43% vs. 90% lately, and graft rejection of 29% vs. 4%). The favorable outcome of bone marrow transplantation for severe or very severe aplastic anemia is due to: the use of conditioning with antithymocyte globuline and cyclophosphamide, the use of graft-vs.-host disease prophylaxis with short curse methotrexate and cyclosporine and the use of filtrated and irradiated blood products. For those patients without an HLA-matched related donor the first treatment to use is the immunosuppression with antithymocyte globuline and cyclosporine. Another option emerged in the late 80’s is the unrelated bone marrow transplantation, with survival hardly half of the HLA-identical related bone marrow transplants. In our country, the first allogeneic bone marrow transplant was done in the Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, in a patient with aplastic anemia, making possible to perform this procedure safely in our country.


REFERENCES

  1. Camitta BM, Thomas ED, Nathan DG, et al. Severe aplastic anemia: a prospective study of the effect of early marrow transplantation on acute mortality. Blood 1976; 48: 63-70.

  2. Camitta BM, Thomas ED, Nathan DG, et al. A prospective study of androgens and bone marrow transplantation for the treatment of severe aplastic anemia. Blood 1979; 53: 504.

  3. Bacigalupo A, Hows J, Gluckman E, et al. Bone Marrow Transplantation versus immunosuppression for the treatment of severe aplastic anemia: a report of the EBMT SAA working party. Br J Hematol 1988; 70: 177.

  4. Storb R, Longton Ansetti C, et al. Changing trends in marrow transplantation for aplastic anemia. Bone Marrow Transplantation 1992; 10 (Suppl. 1): 45.

  5. Beutler E, Lichtman MA, Coller B, et al. Allogeneic and autologous hematopoietic cell transplantation. 6a. Ed. In: Williams Hematology (Edit.): Mc Graw Hill; 2001.

  6. Pillow RP, Epstein RB, Buckner CD, Giblet ER, Thomas ED. Treatment of bone-marrow failure by isogeneic marrow infusion. N Engl J Med 1966; 275: 94-7.

  7. Gillio AP, Bouland F, Small TN, et al. Comparison of long term outcome of children with severe aplastic anemia treated with immunosuppression versus bone marrow transplantation. Biol Blood Marrow Transplant 1997; 3: 18.

  8. Schrezenmeir H, Marin P, Raghavachar A, et al. Relapse of aplastic anemia after immunosuppressive treatment: a report from the European Bone Marrow Transplantation Group SAA Working Party. Br J Haematol 1993; 85: 371.

  9. Tichelli A, Grathwohl A, Nissen C, Speck B. Late clonal complications in severe aplastic anemia. Leuk Lymphoma 1994; 12: 167.

  10. Wagner JL, Storb R. Allogeneic transplantation for aplastic anemia en hematopoietic cell transplantation. Capítulo 67. 2a. Ed. Boston: Blackwell Science; 1999, p. 791-806.

  11. Hinterberger W, Rowlings PA, Hinterberger-Fisher M, et al. Results of transplanting bone marrow from genetically identical twins into patients with aplastic anemia. Ann Intern Med 1997; 126: 116-22.

  12. Storb R, Lucarelli G, McSweeney P, Childs R. Hematopoietic cell transplantation for benign hematological disorders and solid tumors. Hematology 2003; ASH. 372-97.

  13. Storb R, Prentice R, Donnall T. Treatment of aplastic anemia by marrow transplantation from HLA identical siblings. J Clin Invest 1977; 59: 625-32.

  14. Storb R, Blume KG, O’Donnell MR, et al. Cyclophosphamide and antithymocyte globuline to condition patients with aplastic anemia for allogeneic marrow transplantations: the experience in four centers. Biol Blood Marrow Transplant 2001; 7: 39-44.

  15. Horowitz MM. Current status of allogeneic marrow transplantation in acquired aplastic anemia. Semin Hematol 2000; 37: 30-42.

  16. Storb R, Thomas ED, Buckner CD, et al. Marrow transplantation in thirty untransfused patients with severe aplastic anemia. Ann Intern Med 1980; 92: 30-6.

  17. Storb R, Weiden PL, Sullivan KM, et al. Second marrow transplants in patients with aplastic anemia rejecting the first graft: use of a conditioning regimen including cyclophosphamide and antithymocyte globuline. Blood 1987; 70: 116-21.

  18. Storb R, Etzioni R, Anasetti C, et al. Cyclophosphamide combined with antithymocyte globuline in preparation for allogeneic marrow transplants in patients with aplastic anemia. Blood 1994; 84: 941-9.

  19. Storb R, Deeg HJ, Farewell V, et al. Marrow transplantation for severe aplastic anemia: methotrexate alone compared with a combination of methotrexate and cyclosporine for prevention of acute graft versus host disease. Blood 1986; 68: 119-25.

  20. Passweg JR, Socié G, Hinterberger W, et al. Bone marrow transplant for severe aplastic anemia: has outcome improved? Blood 1997; 90: 858-64.

  21. Deeg HJ, Socié G, Schoch G, et al. Malignancies after bone marrow transplant for aplastic anemia and Fanconi anemia: a joint Seattle and Paris analysis of results in 700 patients. Blood 1996; 87: 386-92.

  22. Deeg HJ. Delayed complications after hematopoietic cell transplantation. In: Thomas ED, Blume KG, Forman SJ Eds. Hematopoietic cell transplantation. 2a. Ed. Capítulo 67. Boston: Blackwell Science; 1999, p. 791-806.

  23. Abkowitz J. Aplastic anemia: wich treatment? Ann Intern Med 2001; 135: 524-26.

  24. Sosa-Sánchez R, Córdova S, Labardini J, Chávez-Peón F. Trasplante de médula ósea en anemia aplástica. Reporte del primer trasplante en México. Rev Invest Clin 1980; 32: 49-55.

  25. León-Rodríguez E, Sosa-Sánchez R, Gómez E, Ochoa-Sosa C. Trasplante de médula ósea en anemia aplástica. Experiencia en una institución mexicana. Rev Invest Clin 1993; 45: 559-64.




2020     |     www.medigraphic.com