Choice of bone marrow transplantation as treatment for severe aplastic anaemia.

Bone marrow transplantation is the first line of treatment for all patients with aplastic anaemia who have an identical twin. Age is not an important consideration in these circumstances. For patients with an HLA identical sibling donor bone marrow transplantation should be offered as a matter of urgency to those patients with SAA under the age of 50. The most controversial issue is the use of unrelated volunteers, or non-sibling family members who are phenotypically matched or who have a minor degree of mismatch of the HLA system. A strong case could be made for offering this form of transplant to all patients under the age of 20 who have VSAA and using it as the second line of treatment in patients who fail to respond to ALG after 4 months if they have VSAA.