MUD for aplastic anemia – pro

Allogeneic bone marrow transplantation from human leukocyte antigen (HLA)-matched, related donors is generally accepted as the initial treatment of choice for young patients (< 20 years old). It results in the complete reconstitution of hematopoiesis, whereas autologous hematopoietic remissions after immunosupression (IST) are more susceptible to relapse. The literature indicates that survival rates after ABMT, in patients between the ages of 20 and 40, are comparable to those reported for IST. Better survival rates after ABMT have been attained with improved conditioning regimens and graft-versus-host disease (GVHD) prophylaxis. Best current results demonstrate long-term, event-free survivals with successful allografts on the order of 90%. Long-term complications after ABMT include GVHD and secondary neoplasms. The role of ABMT from an unrelated donor is being investigated. MUD transplants have a greater incidence of severa gVHD and infections, especially CMV. Marsh et al write: “1.MUD BMT may be considered when a patient has a fully matched donor, is <50 years old (or 50–60 years old with good performance status), has failed at least one course of ATG and ciclosporin, and has severe aplastic anaemia. There is currently insufficient data on outcome for patients >60 years of age.
2.The optimal conditioning regimen for MUD BMT is uncertain, but currently a fludarabine, non–irradiation-based regimen is favoured for younger patients. ”

Scheinberg P, Cooper JN, Sloand EM, Wu CO, Calado RT, Young NS. Association of telomere length of peripheral blood leukocytes with hematopoietic relapse, malignant transformation, and survival in severe aplastic anemia. JAMA. Sep 22 2010;304(12):1358-64. [Medline].

Chan KW, McDonald L, Lim D, Grimley MS, Grayson G, Wall DA. Unrelated cord blood transplantation in children with idiopathic severe aplastic anemia. Bone Marrow Transplant. Nov 2008;42(9):589-95.

Kojima S, Nakao S, Tomonaga M, et al. Consensus Conference on the Treatment of Aplastic Anemia. Int J Hematol. 2000b;72(1):118-123.

Marsh JC, Ball SE, Cavenagh J, Darbyshire P, Dokal I, Gordon-Smith EC, Keidan J, Laurie A, Martin A, Mercieca J, Killick SB, Stewart R, Yin JA, British Committee for Standards in Haematology. Guidelines for the diagnosis and management of aplastic anaemia. Br J Haematol 2009 Oct;147(1):43-70. [175 references]

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