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Frontline-matched sibling donor transplant of aplastic anemia patients using primed versus steady-state bone marrow grafts
El Fakih, R., Alfraih, F., Alhayli, S., Ahmed, S. O., Shaheen, M., Chaudhri, N., Alsharif, F., Hanbali, A., Alshaibani, A., Alotaibi, A. S., et al
Annals of hematology. 2021
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Abstract
Priming donors with G-CSF before BM harvest is reported to improve engraftment and GvHD in recipients. These effects are highly desirable when transplanting patients with non-neoplastic hematologic diseases, particularly AA patients. Here we retrospectively report the outcomes of 39 AA patients receiving a primed BM graft from MSD to 43 patients receiving a steady-state BM graft from MSD, otherwise transplanted using a uniform transplant platform. The graft had higher TNC and CD34 cell concentrations in the primed group (p?0.001), and that was reflected in higher TNC and CD34 doses per kilogram of recipient in the primed group (p?=?0.004 and 0.03, respectively). The OS for primed BM graft recipients was 97.4% and 78.9% for the steady-state BM graft recipients, p-value?=?0.01. The cumulative incidence of death without GF was 2.6% in the primed group and 16.3% in the steady-state group, p-value?=?0.03. There was no difference in GvHD incidence between the two groups. We confirm that priming improved the TNC and CD34 graft concentration and cell dose; this evidence along with other reported studies constitute reasonable evidence to prove that BM priming improve engraftment. We observed no increase in GvHD using primed BM graft.
PICO Summary
Population
Patients with aplastic anaemia, undergoing matched sibling donor transplant (n=82)
Intervention
Bone marrow (BM) graft primed with G-CSF before bone marrow harvest (n=39)
Comparison
Steady state BM graft (n=43)
Outcome
The graft had higher TNC and CD34 cell concentrations in the primed group, and that was reflected in higher TNC and CD34 doses per kilogram of recipient in the primed group. The overall survival for primed BM graft recipients was 97.4% and 78.9% for the steady-state BM graft recipients. The cumulative incidence of death without graft failure was 2.6% in the primed group and 16.3% in the steady-state group. There was no difference in GvHD incidence between the two groups.