Bone marrow transplantation is an effective therapy for severe aplastic anemia and is generally considered the preferable treatment for young patients who have an HLA (Human Leukocyte Antigen) identical sibling donor. Recent studies report 55% to 80% extended survival. Graft failure owing to rejection or others causes remains an important life-threatening complication following allogeneic bone marrow transplantation for aplastic anemia. It occurs in 55% to 60% of patients receiving HLA identical transplants, using different immunosuppressive therapies before and after transplant. The BMT Unit of Federal University of Paraná had 178 cases of SAA transplants from 1993 to 2001 using either cyclophosphamide (CY) alone or associated with busulfan (CY+BU) for conditioning regimen. Graft failure occurred in 39 of the cases. Among patients conditioned with CY, 24 (46%) presented graft failure, of whom 3 (6%) suffered primary graft failures and 21 (40%) transient engraftment. Among patients conditioned with BU+CY, 15 (12%) suffered graft failure, 4 (3%) primary graft failures and 11 (9%) transient engraftment. The patients conditioned with CY and experienced rejection had a survival of around 80%, because they underwent another transplantation or due to immunosuppressive treatment with cyclosporin A. The patients conditioned with BU+CY who suffered rejections had a survival of approximately 35%.
Bone marrow transplantation; severe aplastic anemia; rejection; primary graft failure; cyclophosphamide; busulfan
