Optimization of therapy for severe aplastic anemia based on clinical, biologic, and treatment response parameters: conclusions of an international working group on severe aplastic anemia convened by the Blood and Marrow Transplant Clinical Trials Network, March 2010

Michael A Pulsipher, Neal S Young, Jakub Tolar, Antonio M Risitano, H Joachim Deeg, Paolo Anderlini, Rodrigo Calado, Seiji Kojima, Mary Eapen, Richard Harris, Phillip Scheinberg, Sharon Savage, Jaroslaw P Maciejewski, Ramon V Tiu, Nancy DiFronzo, Mary M Horowitz, Joseph H Antin, Michael A Pulsipher, Neal S Young, Jakub Tolar, Antonio M Risitano, H Joachim Deeg, Paolo Anderlini, Rodrigo Calado, Seiji Kojima, Mary Eapen, Richard Harris, Phillip Scheinberg, Sharon Savage, Jaroslaw P Maciejewski, Ramon V Tiu, Nancy DiFronzo, Mary M Horowitz, Joseph H Antin

Abstract

Although recent advances in therapy offer the promise for improving survival in patients with severe aplastic anemia (SAA), the small size of the patient population, lack of a mechanism in North America for longitudinal follow-up of patients, and inadequate cooperation among hematologists, scientists, and transplant physicians remain obstacles to conducting large studies that would advance the field. To address this issue, the Blood and Marrow Transplant Clinical Trials Network (BMT CTN) convened a group of international experts in March 2010 to define the most important questions in the basic science, immunosuppressive therapy (IST), and bone marrow transplantation (BMT) of SAA and propose initiatives to facilitate clinical and biologic research. Key conclusions of the working group were: (1) new patients should obtain accurate, expert diagnosis and early identification of biologic risk; (2) a population-based SAA outcomes registry should be established in North America to collect data on patients longitudinally from diagnosis through and after treatment; (3) a repository of biologic samples linked to the clinical data in the outcomes registry should be developed; (4) innovative approaches to unrelated donor BMT that decrease graft-versus-host disease are needed; and (5) alternative donor transplantation approaches for patients lacking HLA-matched unrelated donors must be improved. A partnership of BMT, IST, and basic science researchers will develop initiatives and partner with advocacy and funding organizations to address these challenges. Collaboration with similar study groups in Europe and Asia will be pursued.

Copyright © 2011 American Society for Blood and Marrow Transplantation. All rights reserved.

Figures

Figure 1
Figure 1
Treatment of Acquired Severe Aplastic Anemia According to United Kingdom Guidelines.(13) ATG, antithymocyte globulin; CSA, cyclosporine; FBC, full blood count (or CBC); MUD, matched unrelated donor; CRP, clinical research protocol; IST, immunosuppressive therapy; UCB, umbilical cord blood.
Figure 2
Figure 2
Probability of survival in patients treated with IST who had high vs. low absolute reticulocyte counts (ARC) and high vs. low absolute lymphocyte counts (ALC). Patients undergoing BMT were censored at the time of transplant.(27)
Figure 3
Figure 3
Survival among patients with severe aplastic anemia treated with ATG-based immunosuppression reported to the EBMT database (n=2400).(36)
Figure 4. Outcomes of URD BMT for…
Figure 4. Outcomes of URD BMT for SAA using
Fludarabine/Cyclophosphamide/ATG ± low dose TBI reported to the EBMT. A) Survival after Flu/Cy/ATG with TBI (median age 27 (7-53) )vs. Flu/Cy/ATG (median age 13(3-51)). B) Survival of patients transplanted ≤ 2 years from diagnosis vs. those receiving transplantation later in their disease course. C) Survival of patients transplanted in the most recent era (after 2004 vs. those transplanted earlier.(11)
Figure 4. Outcomes of URD BMT for…
Figure 4. Outcomes of URD BMT for SAA using
Fludarabine/Cyclophosphamide/ATG ± low dose TBI reported to the EBMT. A) Survival after Flu/Cy/ATG with TBI (median age 27 (7-53) )vs. Flu/Cy/ATG (median age 13(3-51)). B) Survival of patients transplanted ≤ 2 years from diagnosis vs. those receiving transplantation later in their disease course. C) Survival of patients transplanted in the most recent era (after 2004 vs. those transplanted earlier.(11)

Source: PubMed

3
Abonneren