Graft failure following bone marrow transplantation for severe aplastic anemia: risk factors and treatment results.
Graft failure following bone marrow transplantation for severe aplastic anemia: risk factors and treatment results.
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DOI：
10.1182/blood.v73.2.606.bloodjournal732606
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发表时间：
1989-02
期刊：
影响因子：
20.3
通讯作者：
Richard;-E.;Champlin;Mary;-M.;Horowitz;Dirk;-W.;Van;Bekkum;Bruce;Camitta;Gerald;Elfenbein;Robert;Peter;Gale;Eliane;Gluckman;-A.;Good;Alfred;Rimm;Ciril;Rozman;Bruno;Speck;Mortimer;Bortin
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文献类型：
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作者：
Richard;-E.;Champlin;Mary;-M.;Horowitz;Dirk;-W.;Van;Bekkum;Bruce;Camitta;Gerald;Elfenbein;Robert;Peter;Gale;Eliane;Gluckman;-A.;Good;Alfred;Rimm;Ciril;Rozman;Bruno;Speck;Mortimer;Bortin
对625例接受同种异体骨髓移植治疗严重再生障碍性贫血的患者进行了移植失败分析。68例（11%）没有植入或只有短暂植入。第二次骨髓移植在27例短暂初始移植患者中有16例成功延长了生存期，但在第一次移植后无移植迹象的10例患者中没有一例成功延长了生存期。与移植物失败风险降低相关的主要因素是使用放疗进行移植前免疫抑制和使用环孢素而不是甲氨蝶呤或供体骨髓t细胞耗竭预防移植物-v-宿主病（GVHD）。在266例单独使用环磷酰胺准备移植的患者中，先前接受过输血的患者移植失败的风险增加，而先前接受过皮质类固醇治疗的患者移植失败的风险降低。细胞剂量和给药均不影响移植的可能性。虽然在调理中使用放疗减少了移植物衰竭，但生存率没有提高。移植后环孢素治疗和避免移植前输血与生存率提高相关。
Graft failure was analyzed in 625 patients receiving allogeneic bone marrow transplants from HLA-identical sibling donors as treatment for severe aplastic anemia. Sixty-eight (11%) had no or only transient engraftment. Second bone marrow transplants were successful in achieving extended survival in 16 of 27 patients with transient initial engraftment but in none of ten patients with no sign of engraftment after the first transplant. The major factors associated with a reduced risk of graft failure were use of radiation for pretransplant immunosuppression and use of cyclosporine rather than methotrexate or T-cell depletion of the donor bone marrow for prophylaxis against graft-v-host disease (GVHD). Among 266 patients prepared for transplantation with cyclophosphamide alone, the risk of graft failure was increased in patients who received previous transfusions and reduced in those who received corticosteroids for previous therapy. Neither cell dose nor administration of donor buffy coat cells affected the probability of engraftment. Although use of radiation in conditioning reduced graft failure, survival was not improved. Posttransplant treatment with cyclosporine and avoidance of pretransplant blood transfusions were associated with improved survival.