McCann S R, Bacigalupo A, Gluckman E, Hinterberger W, Hows J, Ljungman P, Marin P, Nissen C, van't Veer Kerthof E, Raghavachar A
Department of Haematology, St. James Hospital, Dublin, Ireland.
Bone Marrow Transplant. 1994 Mar;13(3):233-7.
Six hundred and eighteen patients with acquired aplastic anaemia grafted from an HLA-identical sibling donor between 1976 and 1990 in eight European centres were reported to the Working Party for Severe Aplastic Anaemia (SAA) Registry and were evaluable for analysis of the incidence of graft failure/rejection and the outcome of second bone marrow transplants (BMT). The number of patients experiencing graft rejection declined significantly over the study period from 32% to 8% (p < 0.0001). This coincided with the introduction of cyclosporine to the conditioning regimen for BMT. The graft rejection rate in the post-hepatitis SAA group was significantly lower than in the group with idiopathic SAA (4% vs 20%) (p = 0.001). The use of irradiation in the conditioning regimen significantly reduced the number of patients experiencing graft rejection (7% vs 21%) (p = 0.004). Age, sex and severity of disease did not influence the rate of sustained engraftment. Of the 85 patients experiencing graft rejection, 41 received a second transplant: their survival is 33% vs 8% for patients not transplanted a second time (p = 0.003). The major factor predicting the outcome of second BMT for SAA was the interval from first BMT. Patients receiving a second BMT within 60 days from the first BMT had a significantly poorer outcome.
1976年至1990年间，欧洲8个中心有618例获得性再生障碍性贫血患者接受了来自HLA相合同胞供者的移植，并被报告给严重再生障碍性贫血（SAA）登记工作组，可用于分析移植失败/排斥的发生率以及第二次骨髓移植（BMT）的结果。在研究期间，发生移植排斥的患者数量从32%显著下降至8%（p<0.0001）。这与环孢素被引入BMT预处理方案的时间相吻合。肝炎后SAA组的移植排斥率显著低于特发性SAA组（4%对20%）（p=0.001）。预处理方案中使用放疗显著减少了发生移植排斥的患者数量（7%对21%）（p=0.004）。年龄、性别和疾病严重程度不影响持续植入率。在85例发生移植排斥的患者中，41例接受了第二次移植：他们的生存率为33%，而未接受第二次移植的患者为8%（p=0.003）。预测SAA第二次BMT结果的主要因素是距首次BMT的时间间隔。在首次BMT后60天内接受第二次BMT的患者结局明显较差。
