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
Raynier Devillier,
Jean-Hugues Dalle,
Austin Kulasekararaj,
Maud D’aveni,
Laurence Clément,
Alicja Chybicka,
Stéphane Vigouroux,
Patrice Chevallier,
Mickey Koh,
Yves Bertrand,
Mauricette Michallet,
Marco Zecca,
Ibrahim Yakoub-Agha,
Jean-Yves Cahn,
Per Ljungman,
Marc Bernard,
Pascale Loiseau,
Valérie Dubois,
Sébastien Maury,
Gérard Socié,
Carlo Dufour,
Regis Peffault de Latour
Affiliations
Raynier Devillier
Hematology Department, Institut Paoli Calmettes, Marseille, France
Jean-Hugues Dalle
Pediatric Hematology Unit, Robert Debré University Hospital, Paris, France
Austin Kulasekararaj
Hematology Department, King’s College Hospital, London, UK
Maud D’aveni
Pediatric Hematology Unit, University Hospital, Nancy, France
Laurence Clément
Pediatric Hematology Unit, University Hospital, Nancy, France;Hematology Department, Haut-Leveque Hospital and Bordeaux University Hospital, Pessac, France
Alicja Chybicka
Hematology Department, Wroclaw Medical University, Poland
Stéphane Vigouroux
Hematology Department, Haut-Leveque Hospital and Bordeaux University Hospital, Pessac, France
Patrice Chevallier
Hematology Department, University Hospital, Nantes, France
Mickey Koh
Hematology Department, St. George’s Hospital, London, UK
Yves Bertrand
Pediatric Hematology Unit, University Hospital, Lyon, France
Mauricette Michallet
Hematology Department, University Hospital, Lyon, France
Marco Zecca
Hematology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Ibrahim Yakoub-Agha
Hematology Department, University Hospital, Lille, France
Jean-Yves Cahn
Hematology Department, University Hospital, Grenoble, France
Per Ljungman
Hematology Department, Karolinska University Hospital, Stockholm, Sweden
Marc Bernard
Hematology Department, University Hospital, Rennes, France
Pascale Loiseau
HLA Laboratory, Saint-Louis University Hospital, Paris, France;French Society of Histocompatibility and Immunogenetics (SFHI), France
Valérie Dubois
HLA Laboratory, Etablissement Français du Sang, Lyon, France
Sébastien Maury
Hematology Department, Henri Mondor Hospital, Créteil, France
Gérard Socié
BMT Department, Saint-Louis Hospital, Diderot Paris 7 University, Paris, France
Carlo Dufour
Clinical and Experimental Haematology Unit, Giannina Gaslini Children’s Hospital, Genova, Italy
Regis Peffault de Latour
BMT Department, Saint-Louis Hospital, Diderot Paris 7 University, Paris, France
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
