Unrelated donor marrow transplantation for severe aplastic anaemia.

Severe aplastic anaemia (SAA) is frequently a lethal disease. Allogeneic marrow transplantation may offer the best chance of a cure but more than 50% of eligible patients will lack a suitable family donor. The development of large volunteer registries has established unrelated donor marrow transplantation (UD-BMT) as a possible alternative in these patients. Early clinical studies indicate that UD-BMT for SAA is associated with a significantly greater risk of graft rejection and graft-versus-host disease (GVHD) than identical sibling BMT. Current strategies for improving results of UD-BMT for SAA include improved patient selection, more precise HLA matching between recipient and unrelated donor, and the use of more intensive pre-BMT immunosuppression and GVHD prophylaxis.