Comparing Outcomes with Bone Marrow or Peripheral Blood Stem Cells as Graft Source for Matched Sibling Transplants in Severe Aplastic Anemia across Different Economic Regions

Rajat Kumar, Fumihiko Kimura, Kwang Woo Ahn, Zhen Huan Hu, Yachiyo Kuwatsuka, John P. Klein, Marcelo Pasquini, Koichi Miyamura, Koji Kato, Ayami Yoshimi, Yoshihiro Inamoto, Tatsuo Ichinohe, William Allen Wood, Baldeep Wirk, Matthew Seftel, Philip Rowlings, David I. Marks, Kirk R. Schultz, Vikas Gupta, Laurence DedekenBiju George, Jean Yves Cahn, Jeff Szer, Jong Wook Lee, Aloysius Y.L. Ho, Anders Fasth, Theresa Hahn, Nandita Khera, Jignesh Dalal, Carmem Bonfim, Mahmoud Aljurf, Yoshiko Atsuta, Wael Saber

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12 Citations (Scopus)


Bone marrow (BM) is the preferred graft source for hematopoietic stem cell transplantation (HSCT) in severe aplastic anemia (SAA) compared with mobilized peripheral blood stem cells (PBSCs). We hypothesized that this recommendation may not apply to those regions where patients present later in their disease course, with heavier transfusion load and with higher graft failure rates. Patients with SAA who received HSCT from an HLA-matched sibling donor from 1995 to 2009 and reported to the Center for International Blood and Marrow Transplant Research or the Japan Society for Hematopoietic Cell Transplantation were analyzed. The study population was categorized by gross national income per capita and region/countries into 4 groups. Groups analyzed were high-income countries (HIC), which were further divided into United States-Canada (n = 486) and other HIC (n = 1264); upper middle income (UMIC) (n = 482); and combined lower-middle, low-income countries (LM-LIC) (n = 142). In multivariate analysis, overall survival (OS) was highest with BM as graft source in HIC compared with PBSCs in all countries or BM in UMIC or LM-LIC (P < .001). There was no significant difference in OS between BM and PBSCs in UMIC (P = .32) or LM-LIC (P = .23). In LM-LIC the 28-day neutrophil engraftment was higher with PBSCs compared with BM (97% versus 77%, P = .002). Chronic graft-versus-host disease was significantly higher with PBSCs in all groups. Whereas BM should definitely be the preferred graft source for HLA-matched sibling HSCT in SAA, PBSCs may be an acceptable alternative in countries with limited resources when treating patients at high risk of graft failure and infective complications.

Original languageEnglish
Pages (from-to)932-940
Number of pages9
JournalBiology of Blood and Marrow Transplantation
Issue number5
Publication statusPublished - May 1 2016
Externally publishedYes


All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

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