BONE MARROW TRANSPLANTATION VERSUS IMMUNOSUPPRESSIVE THERAPY IN SEVERE APLASTIC ANEMIA, 1990 – 2001

Background – Bone marrow transplantation (BMT) and immunosuppressive therapy are two choices of therapy for aplastic anemia. In BMT, abnormal cells are replaced by normal donor’s hematopoetic stem cells in those patients who have an HLA-identical match donor and are aged < 45 years old. In immunosuppressive therapy, antilymphocyte globulin (ALG) and cyclosporin are used in patients who do not have an HLA-identical match donor and are aged > 45 years old. Methods – In this study we compared these two modalities of treatment in acquired severe aplastic anemia. We had 70 patients in two groups. Twenty-nine patients had completed BMT and 41 patients had completed non-BMT treatment. The conditioning regimen in BMT group was cyclophosphamide plus ALG. Patients with severe aplastic anemia who had been referred to the Hematology Clinic of Shariati Hospital from 1990 through 2001, were selected according to age (< 45 or > 45 years) and presence of HLA match donor. Ethical considerations were strictly followed. Data were analyzed by SPSS version 10. Survival probabilities were estimated using Kaplan-Meier method. Results – The 5 years overall survival in BMT group was 67% and in cyclosporin group was 36.6% and we found that after the day 200 posttherapy overall survival in BMT group was higher in comparison with non-BMT treatment (p = 0.02). Conclusion – BMT has the best results and long-term survival in severe aplastic anemia patients.