Relapse of Aplastic Anemia with Majority Donor Chimerism (Donor-Type Aplasia) Occurring Late after Bone Marrow Transplantation

Aplastic Anaemia Working Party of the European Society for Blood and Marrow Transplantation

Research output: Contribution to journalArticlepeer-review

Abstract

There have been sporadic reports of the development of delayed disease recurrence after bone marrow transplantation for severe aplastic anemia despite sustained majority or full donor chimerism. This is termed “donor-type aplasia” (DTA). We describe the management and outcome of 11 pediatric patients from 8 institutions in Europe, the United States, and the Middle East who developed DTA at a mean of 35 months post-transplant. These patients were initially transplanted at a mean age of 10.0 years (range, 5.8 to 16.0 years), 9 from matched sibling donors and 2 from matched unrelated donors. Attempts to treat DTA with varying combinations of additional immunosuppression (including intravenous immunoglobulin, donor lymphocyte infusions, stem cell boosts, and other therapies) failed. Ten patients have received a conditioned second transplant, 9 from the same donor and 1 from a new matched unrelated donor. Aplasia has resolved in the remaining patient in response to ongoing eltrombopag therapy. All patients were alive at a mean of 92 months (range, 26 to 195) after a second transplant; 6 are in complete remission, but 4 suffered from second/recurrent DTA at 16 to 129 months after retransplant and required further transplant therapy.

Original languageEnglish
Pages (from-to)480-485
Number of pages6
JournalBiology of Blood and Marrow Transplantation
Volume26
Issue number3
DOIs
StatePublished - Mar 2020
Externally publishedYes

Keywords

  • Aplastic anemia
  • Chimerism testing
  • Donor-type aplasia
  • Hematopoietic stem cell transplantation

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