Publication

Abstract : Background Hematopoietic Stem Cell Transplant (HSCT) is the most effective therapy for Aplastic Anemia (AA). Use of cyclosporine as Graft Versus Host Disease (GVHD) prophylaxis has improved outcome over period of years. Age, severity of AA is most important predictors of survival in AA. However, In India due to signifi cant time delay between diagnoses to HSCT, alloimmunisation is very important factor in outcome. Aim To evaluate short and long term outcome of HSCT in patients with severe alpastic anemia in Indian settings. Methodology We reviewed medical records of 30 HSCT performed over last 5 years, at our institution retrospectively with respects to different variables and analyzed systematically. Fludarabine/ATG/ Cyclophosphamide conditioning regimen was used in all. G-GSF was given to all from D+1. Antibacterial and antifungal prophylaxis was administered along with conditioning, and at the onset of fever, systemic antibiotics were started. Antifungal agents were added if fever persisted for 3 days. Results We present our experience of 30 transplants performed in 28 patients with severe aplastic anemia over period of last 5 years. All these transplants performed in non-HEPA fi ltered single room. Out of these, 20 were males and 10 females. Median age of patients was 25.5 years (9-37). In 28 out of 30 patients PBSC was used as source for transplant as compared to 2 patients with BM as source. Median Time from diagnosis to transplant - 10.5 months (1-65) with median number of blood transfusions- 30 (3-106). Fever occurred in all patients requiring initiation of antibiotics. Antifungal were used in 14 (46.6%). Median Day of Neutrophil Engraftment - 10 (8-17) and that of platelet engraftment– 15 (10-33). There were 3 secondary graft failures, 1 of which was successfully transplanted again from same donor. 8 patients and 9 patients developed acute and chronic GVHD respectively. 7 out 9 of chronic GVHD patients had acute GVHD proceeding to it. The 30-day mortality was 1(3.3%), and 100-day mortality was 3 (10%). After day 100, there were seven fatalities (26.5%) due to chronic GVHD-3, graft rejection-1, infections like disseminated tuberculosis-1 and aspergillosis-1, platelet refractoriness leading to IC bleed-1. In these patients who died, median time from diagnosis to transplant was higher at 14 months (3-60) compared to 8 months (1-65), and median number of Blood transfusions was also higher at 85 (50-92) compared to 23(3-106). Conclusions Time to transplant from diagnosis and number of blood transfusions are signifi cantly associated with poor outcome. Acute GVHD is most important risk factor for chronic GVHD. Uncontrolled Infections and GVHD are two most important risk factors determine poor outcome