Comparing Outcomes with Bone Marrow or Peripheral Blood Stem Cells as Graft Source for Matched Sibling Transplants in Severe Aplastic Anemia across Different Economic Regions

Rajat Kumar, Fumihiko Kimura, Kwang Woo Ahn, Zhen Huan Hu, Yachiyo Kuwatsuka, John P. Klein, Marcelo Pasquini, Koichi Miyamura, Koji Kato, Ayami Yoshimi, Yoshihiro Inamoto, Tatsuo Ichinohe, William Allen Wood, Baldeep Wirk, Matthew Seftel, Philip Rowlings, David I. Marks, Kirk R. Schultz, Vikas Gupta, Laurence DedekenBiju George, Jean Yves Cahn, Jeff Szer, Jong Wook Lee, Aloysius Y L Ho, Anders Fasth, Theresa Hahn, Nandita D Khera, Jignesh Dalal, Carmem Bonfim, Mahmoud Aljurf, Yoshiko Atsuta, Wael Saber

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Bone marrow (BM) is the preferred graft source for hematopoietic stem cell transplantation (HSCT) in severe aplastic anemia (SAA) compared with mobilized peripheral blood stem cells (PBSCs). We hypothesized that this recommendation may not apply to those regions where patients present later in their disease course, with heavier transfusion load and with higher graft failure rates. Patients with SAA who received HSCT from an HLA-matched sibling donor from 1995 to 2009 and reported to the Center for International Blood and Marrow Transplant Research or the Japan Society for Hematopoietic Cell Transplantation were analyzed. The study population was categorized by gross national income per capita and region/countries into 4 groups. Groups analyzed were high-income countries (HIC), which were further divided into United States-Canada (n = 486) and other HIC (n = 1264); upper middle income (UMIC) (n = 482); and combined lower-middle, low-income countries (LM-LIC) (n = 142). In multivariate analysis, overall survival (OS) was highest with BM as graft source in HIC compared with PBSCs in all countries or BM in UMIC or LM-LIC (P <.001). There was no significant difference in OS between BM and PBSCs in UMIC (P = .32) or LM-LIC (P = .23). In LM-LIC the 28-day neutrophil engraftment was higher with PBSCs compared with BM (97% versus 77%, P = .002). Chronic graft-versus-host disease was significantly higher with PBSCs in all groups. Whereas BM should definitely be the preferred graft source for HLA-matched sibling HSCT in SAA, PBSCs may be an acceptable alternative in countries with limited resources when treating patients at high risk of graft failure and infective complications.

Original languageEnglish (US)
Pages (from-to)932-940
Number of pages9
JournalBiology of Blood and Marrow Transplantation
Volume22
Issue number5
DOIs
StatePublished - May 1 2016

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Aplastic Anemia
Siblings
Bone Marrow
Economics
Transplants
Hematopoietic Stem Cell Transplantation
Peripheral Blood Stem Cells
Pyridinolcarbamate
Survival
Cell Transplantation
Graft vs Host Disease
Canada
Japan
Neutrophils
Multivariate Analysis
Tissue Donors

Keywords

  • Aplastic anemia
  • Economic regions
  • Graft source
  • Hematopoietic cell transplantation

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

Comparing Outcomes with Bone Marrow or Peripheral Blood Stem Cells as Graft Source for Matched Sibling Transplants in Severe Aplastic Anemia across Different Economic Regions. / Kumar, Rajat; Kimura, Fumihiko; Ahn, Kwang Woo; Hu, Zhen Huan; Kuwatsuka, Yachiyo; Klein, John P.; Pasquini, Marcelo; Miyamura, Koichi; Kato, Koji; Yoshimi, Ayami; Inamoto, Yoshihiro; Ichinohe, Tatsuo; Wood, William Allen; Wirk, Baldeep; Seftel, Matthew; Rowlings, Philip; Marks, David I.; Schultz, Kirk R.; Gupta, Vikas; Dedeken, Laurence; George, Biju; Cahn, Jean Yves; Szer, Jeff; Lee, Jong Wook; Ho, Aloysius Y L; Fasth, Anders; Hahn, Theresa; Khera, Nandita D; Dalal, Jignesh; Bonfim, Carmem; Aljurf, Mahmoud; Atsuta, Yoshiko; Saber, Wael.

In: Biology of Blood and Marrow Transplantation, Vol. 22, No. 5, 01.05.2016, p. 932-940.

Research output: Contribution to journalArticle

Kumar, R, Kimura, F, Ahn, KW, Hu, ZH, Kuwatsuka, Y, Klein, JP, Pasquini, M, Miyamura, K, Kato, K, Yoshimi, A, Inamoto, Y, Ichinohe, T, Wood, WA, Wirk, B, Seftel, M, Rowlings, P, Marks, DI, Schultz, KR, Gupta, V, Dedeken, L, George, B, Cahn, JY, Szer, J, Lee, JW, Ho, AYL, Fasth, A, Hahn, T, Khera, ND, Dalal, J, Bonfim, C, Aljurf, M, Atsuta, Y & Saber, W 2016, 'Comparing Outcomes with Bone Marrow or Peripheral Blood Stem Cells as Graft Source for Matched Sibling Transplants in Severe Aplastic Anemia across Different Economic Regions', Biology of Blood and Marrow Transplantation, vol. 22, no. 5, pp. 932-940. https://doi.org/10.1016/j.bbmt.2016.01.012
Kumar, Rajat ; Kimura, Fumihiko ; Ahn, Kwang Woo ; Hu, Zhen Huan ; Kuwatsuka, Yachiyo ; Klein, John P. ; Pasquini, Marcelo ; Miyamura, Koichi ; Kato, Koji ; Yoshimi, Ayami ; Inamoto, Yoshihiro ; Ichinohe, Tatsuo ; Wood, William Allen ; Wirk, Baldeep ; Seftel, Matthew ; Rowlings, Philip ; Marks, David I. ; Schultz, Kirk R. ; Gupta, Vikas ; Dedeken, Laurence ; George, Biju ; Cahn, Jean Yves ; Szer, Jeff ; Lee, Jong Wook ; Ho, Aloysius Y L ; Fasth, Anders ; Hahn, Theresa ; Khera, Nandita D ; Dalal, Jignesh ; Bonfim, Carmem ; Aljurf, Mahmoud ; Atsuta, Yoshiko ; Saber, Wael. / Comparing Outcomes with Bone Marrow or Peripheral Blood Stem Cells as Graft Source for Matched Sibling Transplants in Severe Aplastic Anemia across Different Economic Regions. In: Biology of Blood and Marrow Transplantation. 2016 ; Vol. 22, No. 5. pp. 932-940.
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abstract = "Bone marrow (BM) is the preferred graft source for hematopoietic stem cell transplantation (HSCT) in severe aplastic anemia (SAA) compared with mobilized peripheral blood stem cells (PBSCs). We hypothesized that this recommendation may not apply to those regions where patients present later in their disease course, with heavier transfusion load and with higher graft failure rates. Patients with SAA who received HSCT from an HLA-matched sibling donor from 1995 to 2009 and reported to the Center for International Blood and Marrow Transplant Research or the Japan Society for Hematopoietic Cell Transplantation were analyzed. The study population was categorized by gross national income per capita and region/countries into 4 groups. Groups analyzed were high-income countries (HIC), which were further divided into United States-Canada (n = 486) and other HIC (n = 1264); upper middle income (UMIC) (n = 482); and combined lower-middle, low-income countries (LM-LIC) (n = 142). In multivariate analysis, overall survival (OS) was highest with BM as graft source in HIC compared with PBSCs in all countries or BM in UMIC or LM-LIC (P <.001). There was no significant difference in OS between BM and PBSCs in UMIC (P = .32) or LM-LIC (P = .23). In LM-LIC the 28-day neutrophil engraftment was higher with PBSCs compared with BM (97{\%} versus 77{\%}, P = .002). Chronic graft-versus-host disease was significantly higher with PBSCs in all groups. Whereas BM should definitely be the preferred graft source for HLA-matched sibling HSCT in SAA, PBSCs may be an acceptable alternative in countries with limited resources when treating patients at high risk of graft failure and infective complications.",
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AU - Kumar, Rajat

AU - Kimura, Fumihiko

AU - Ahn, Kwang Woo

AU - Hu, Zhen Huan

AU - Kuwatsuka, Yachiyo

AU - Klein, John P.

AU - Pasquini, Marcelo

AU - Miyamura, Koichi

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AU - Inamoto, Yoshihiro

AU - Ichinohe, Tatsuo

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AU - Marks, David I.

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AU - Gupta, Vikas

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AU - Szer, Jeff

AU - Lee, Jong Wook

AU - Ho, Aloysius Y L

AU - Fasth, Anders

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AU - Dalal, Jignesh

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