Second bone marrow transplantation for severe aplastic anemia: analysis of34 cases

Severe aplastic anemia (sAA) is a bone marrow failure disorder which is mos tly a consequence of immunologically mediated stem cell destruction. Alloge neic bone marrow transplantation (BMT) from a compatible donor provides lon g-term survival in 60 to 80% of sAA patients. However, graft rejection stil l remains a major problem, and a second allograft is an alternative for the se patients. We retrospectively analyzed 34 patients who received a second BMT (BMT2), nine with primary graft failure (PGF) and 25 with transient eng raftment (TE). The probability of survival at 13 years among PGF patients w as 22% vs 60% for the TE group (P = 0.0068). Age (< 17 vs > 17 years), numb er of mononuclear cells (< 3 vs > 3 x 10(8)/kg) and year of transplant (198 6-1991 vs 1992-1998) at BMT2 had no statistical influence on survival. A si gnificant survival advantage was noted among TE patients (P = 0.0068), whic h was probably because of a longer intertransplant interval (> 90 days). Fu rthermore, 90% of patients with positive blood cultures at BMT2 did not sur vive the procedure. We conclude that early detection of primary graft failu re (PGF), followed by measures attempting to promote hematopoietic recovery (eg use of growth factors, further infusion of stem cells) may decrease mo rtality.