Hematopoietic Stem Cell Transplantation for Severe Aplastic Anemia

In Ho Kim; Dae Ho Lee; Soo Mee Bang; Jae Ho Byun; Heung Moon Chang; Moon Hee Lee; Young Jin Yoo; Jin Seok Ahn; Jong Tae Lee; Seok Ah Im; Chul Won Jung; Sung Hyun Yang; Hong Bock Lee; Cheolwon Suh; Myung Don Oh; Kang Won Choe; Kyou Sup Han; Myoung Hee Park; Il Han Kim; Sung Whan Ha; Charn Il Park; Kyunh Hae Jung; Seonyang Park; Byoung Kook Kim

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Korean J Hematol 2000; 35(3):

Published online September 30, 2000

중증 재생불량성 빈혈의 조혈모세포 이식

김인호, 이대호, 방수미, 변재호, 장흥문, 이문희, 유영진, 안진석, 이종태, 임석아, 정철원, 양성현, 이홍복, 서철원, 오명돈, 최강원, 한규섭, 박명희, 김일한, 하성환, 박찬일, 정경해, 박선양, 김병국

서울대학교 의과대학 내과학교실,
서울대학교 의과대학 임상병리과학교실,
서울대학교 의과대학 치료방사선과학교실

Hematopoietic Stem Cell Transplantation for Severe Aplastic Anemia

In Ho Kim, Dae Ho Lee, Soo Mee Bang, Jae Ho Byun, Heung Moon Chang, Moon Hee Lee, Young Jin Yoo, Jin Seok Ahn, Jong Tae Lee, Seok Ah Im, Chul Won Jung, Sung Hyun Yang, Hong Bock Lee, Cheolwon Suh, Myung Don Oh, Kang Won Choe, Kyou Sup Han, Myoung Hee Park, Il Han Kim, Sung Whan Ha, Charn Il Park, Kyunh Hae Jung, Seonyang Park, Byoung Kook Kim

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Department of Internal Medicine, Clinical Pathology and Terapeutic Radiology, College of Medicine, Seoul Naional Universityl, Seoul, Korea

Abstract

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Abstract

Background: The outcome of hematopoietic stem cell transplantation (HSCT) for patients with severe aplastic anemia (SAA) in Seoul National University Hospital was analyzed retrospectively.
Methods: Between January, 1990 and March, 1999, 25 patients with SAA underwent HSCT. Their medical records were reviewed. Statistical analyses were done about survival and complication after HSCT.
Results: The median age of patients was 22(range, 14∼43) and male to female ratio was 18 : 7. Twenty two were HLA matched non- identical siblings. Three were one identical twin, one one-locus mismatched father and one HLA matched unrelated
donor, respectively. Conditioning regimens were CY/TLI (cyclophosphamide, total lymphoid irradiation) for 18 patients, CY/ATG (CY, antithymocyte globulin) for 3, CY/ buffy (CY, unirradiated buffy- coat) for 2, CY/ ATG/TLI for 1, BU/CY (busulfan, CY) for
1. For prophylaxis of graft-versus-host disease (GVHD), cyclosporine and methotrexate were used in all patients except for identical twin. The median nucleated cell dose given to patients was 4.5×10⁸/㎏ (range, 2.0∼5.9). All evaluable
patients achieved absolute neutrophil count of 500/㎕ after median 17 days of HSCT (range, 12∼27) and untransfused platelet count over 20,000/㎕ after median 21 days of HSCT (range, 13∼67). Six patients (24%, grade Ⅰ : 3, Ⅱ : 1, Ⅲ : 1, Ⅳ : 1)
developed acute GVHD and 8 (32%, limited : 4, extensive : 4) developed chronic GVHD. Hepatic venoocclusive disease (VOD) occurred in 2 patients (8%). Rejection occured in 4 patients (16 %), but among 22 allogeneic transplant recipients from HLA matched
siblings, only one (5%) lost graft. After a median follow-up of 32 months (range 9∼120 months), 5 year overall survival of all patients was 87%, and that of 22 allogeneic recipients from HLA matched sibling donors was 95%. Four patients (16%) died.
Causes of death were VOD in one case, rejection with pneumonia one, acute GVHD one. One died from traffic accident in a cured state.
Conclusion: Experiences from our center suggest that HSCT is an effective treatment for patients with severe aplastic anemia. Long- termsurvival is especially excellent for patients who have matched related donors.

Keywords Severe aplastic anemia; Hematopoietic stem cell transplantation;