ALLOGENEIC BONE-MARROW TRANSPLANTATION IN SEVERE APLASTIC-ANEMIA - EXPERIENCE IN A MEXICAN HOSPITAL

During the period of May 1986 through February 1991, nine allogeneic b one marrow transplants (BMT) on eight severe aplastic anemia (SAA) pat ients were performed at the Institute Nacional de la Nutricion Salvado r Zubiran in Mexico City. Mean age at BMT was 18 years (age interval 1 2-30); seven were men; all patients had a clinical history of multiple blood transfusions; six individuals were infected at the time of the transplant. The conditioning regimens were: cyclophosphamide (Cy) in t hree patients; Cy + total nodal radiation in five; and total nodal rad iation only in the second transplant of one patient. Grait versus host disease (GVHD) profilaxis was attempted with methotrexate plus cyclos porin A (CsA) in six patients, methylprednisolone plus CsA in two, and prednisone+CsA in the patient retransplanted. All procedures were car ried out under single reverse isolation without gut decontamination. S even of the nine procedures grafted (two cases died on days + 8 and 25 due to infection). In the surviving, the median time for reaching > 1.0 white blood cells x 10(9)/L was 22 days (time interval 11-31); >0. 5 neutrophils x 10(9)/L in 27 days (time interval 15-42) and the same lapse to reach >50 platelets x 10(9)/L. Length of hospital stay was 42 days (time interval 15-61). Acute GVHD was seen in one of the seven p atients surviving the period of bone marrow aplasia (14%). Of six long term survivors (including one patient with a second transplant) chron ic GVHD was present in four (67%): chronic GVHD was fatal in one indiv idual but was well controlled in three. At the time of this report fiv e out of the eight patients are alive (62.5%). Our results in this sma ll group of patients suggest that allogeneic BMT in SAA is a feasible procedure in our setting.