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.
Fiche publication
Date publication
juillet 2016
Journal
Haematologica
Auteurs
Membres identifiés du Cancéropôle Est :
Dr D'AVENI-PINEY Maud
Tous les auteurs :
Devillier R, Dalle JH, Kulasekararaj A, D'aveni M, Clément L, Chybicka A, Vigouroux S, Chevallier P, Koh M, Bertrand Y, Michallet M, Zecca M, Yakoub-Agha I, Cahn JY, Ljungman P, Bernard M, Loiseau P, Dubois V, Maury S, Socié G, Dufour C, Peffault de Latour R
Lien Pubmed
Résumé
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<0.001). The score was then confirmed on an independent cohort from the European Group for Blood and Marrow Transplantation database of 296 patients, with shorter survival in patients with at least 2 risk factors (Hazard Ratio=2.13; P=0.005) In conclusion, a simple score using age, transplantation timing and HLA matching would appear useful to help physicians in the daily care of patients with severe aplastic anemia.
Mots clés
Adolescent, Adult, Aged, Anemia, Aplastic, diagnosis, Bone Marrow Transplantation, adverse effects, Child, Child, Preschool, Female, France, Graft vs Host Disease, etiology, Humans, Infant, Lymphocyte Depletion, Male, Middle Aged, Prognosis, Severity of Illness Index, Survival Analysis, Transplantation Conditioning, adverse effects, Transplantation, Homologous, Treatment Outcome, Unrelated Donors, Young Adult
Référence
Haematologica. 2016 07;101(7):884-90