Biju George, DM1, Manoranjan Mahapatra2, Pravas Mishra, DM3*, Shashikant Apte, MD, FRCPA4, Sharat Damodar, MD, DM5,6*, Navin Khattry, MD DM7*, Dharma Choudhary, MD, DM8*, Jose Easow, MD9*, Revathi Raj9*, Tulika Seth, MD10*, Soniya Nityanand, MD, PhD11*, Pankaj Malhotra, MD, Additional Professor12, Dinesh Bhurani, MD13*, Ashish Dixit, MD, DM14, Ajay Sharma, MD15, Anupam Chakrapani, MBBS, MD, DM16*, Sameer Ramesh Melinkeri, MD17*, Joseph M John, DM18*, Sunil Bhat, MBBS, MD, FPHO19*, Neeraj Sidharthan20*, Bhausaheb Bagal, MD, DM21*, Aby Abraham, MD, DM1*, Ramesh Nimmagadda9*, T Raja9*, Abhijeet Ganapule, DM1*, V Lakshmanan9*, Fouzia Nambiathayil Abubacker, DM22*, Anu Korula, MD, DM1*, Satyaranjan Das23*, Sanjeevan Sharma23*, Kannan Subramaniam24*, Rayaz Ahmed, MD, DM25*, Narendra Agarwal26*, Alka Khadwal, MD12*, Gaurav Prakash, MBBS, MD, DM12*, Amit Rauthan, DM14, Chirag Shah27, Uday Deotare, MD, DM, MBBS, MNAMS28*, Sanjeev Kumar Sharma, MD, DM29*, Seema S. Bhatwadekar, MD30, Chandran K Nair, MD31*, Kavitha Lakshmi, MSc1*, Velu Nair32, Mammen Chandy, MD33, Alok Srivastava, MD, FRACP1 and Vikram Mathews, DM1
1Department of Haematology, Christian Medical College, Vellore, India
2Hematology, All India Institute Of Medical Sciences, New Delhi, India
3All India Institute of Medical Sciences, New Delhi, India
4Department of Haematology, Sahyadri Speciality Hospital, Pune, India
5Haematology department, Narayana Hrudayalaya Hospital, Bangalore, India
6Narayana Hirudalaya, Bangalore, India
7Tata Memorial Center, ACTREC, Mumbai, India
8BL Kapur Superspecialty Hospital, New Delhi, India
9Apollo Specialty Hospital, Chennai, India
10All India Institute of Medical Sciences Department of Haematology, New Delhi, India
11Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
12Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
13Department of Haematology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India
14Manipal Hospital, Bangalore, India
15Army Hospital( research & referral), Delhi Cantt, New Delhi, India
16Tata Medical Center, KOLKATA, India
17Deenanath Mangeshkar Hospital, Pune, India
18Department of Clinical Haematology, Haemato-Oncology & Bone Marrow (Stem cell) Transplantation, Christian Medical College, Ludhiana, India
19Narayana Multi Specialty Hospital and Mazumdar Shaw Cancer Center, Narayana Health City, Bangalore, India
20Amrita Institute of Medical Sciences, Kochi, India
21Tata Medical Hospital, Navi Mumbai, India
22Department of Hematology, Christian Medical College, Vellore, India
23Army Hospital (R and R), New Delhi, India
24Sahayadri Hospital, Pune, India
25Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
26Rajiv Gandhi Cancer Hospital, New Delhi, India
27Apollo Hospital, Ahmedabad, India
28Sterling Hospital, Ahmedabad, India
29BL Kapur Memorial Hospital, New Delhi, India
30Sterling Hospital, Vadodara, India
31Department of Clinical Hematology & Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
32Haematology, Army Hospital (Research & Referral), New Delhi, India
33Tata Medical Centre, Kolkota, India
Introduction: Allogeneic stem cell transplantation (SCT) is the best form of therapy for a young patient (< 50 years) with severe aplastic anaemia. In developing countries, there is a big time interval between diagnosis and SCT leading to increased transfusions and increased risk of infections, both of which adversely affects transplant outcome. This retrospective analysis is aimed at studying the outcomes of SCT among Indian patients with aplastic anaemia.
Methodology: The Indian Stem cell transplant registry (ISCTR) is a group of transplant physicians representing about 30 active transplant centres in India. This retrospective analysis was done on data reported on 634 patients by 20 centres who reported outcomes of SCT for aplastic anaemia. Data was collected from individual medical records and databases. Analysis was done using SPSS software version 16.0
Results: Six hundred and thirty four patients [445 males and 189 females] with a median age of 21 years (range: 2 – 65) underwent allogeneic SCT between 1990 and March 2015. There were 209 children (age < 15 years). The median time from diagnosis to SCT was 5 months (range: 1 - 120) while the median number of transfusions was 20 (range: 1 - 150). All donors were HLA identical sibling or family donors; matched unrelated and haplo-identical donor transplants were excluded from this analysis.
Conditioning regimen was Cyclophosphamide based (Cy/ Cy+ ATG/ Cy+ TBI/TLI) in 78 patients (12.3%) while majority received Fludarabine with Cyclophosphamide (n = 481; 75.8%) and 75 received other conditioning regimens (Flu/TBI, Flu/Bu, Bu/Cy etc). Graft source was bone marrow [BM] in 124 (19.5%) and peripheral blood stem cells in 510 patients (80.5%). Graft versus host disease (GVHD) prophylaxis predominantly consisted of Cyclosporine and methotrexate in 543 patients (85.6%).
Engraftment was seen in 572 patients (90.4%) while 19 (2.9%) had primary graft failure and 43 (6.7%) expired prior to engraftment due to infection or bleeding. The median time to neutrophil engraftment was 13 days (range: 8 - 21) while platelet engraftment occurred at 13 days (range: 5 - 37). Grade II – IV acute GVHD occurred in 29.3% while grade III-IV was seen in 14.1%. Chronic GVHD was seen in 41% of evaluable patients which was limited in most patients. At a median follow up of 43 months (range: 1 – 264), 431 patients are alive. The 5 yr OS for the entire group is 66.3 + 2.0%. The OS was higher in children compared to adults (73.4 + 3.3% vs 62.8 + 2.5%; p = 0.006), better for Flu/Cy compared to Cy based conditioning (69.8 + 2.2% vs 57.8 + 5.6%; p = 0.002) and better for PBSC compared to BM (68.9 + 2.2% vs 56.1 + 4.8%; p = 0.020). There has been significant improvement in outcomes over the past 15 years [3 yr OS of 41.9 + 1.3% for 1984-1995, 40.9 + 1.2% for 1996-2000, 70.6 + 5.0% for 2001 -2005, 70.3 + 3.1% for 2006-2010 and 68.8 + 3.0% from 2011 onwards].
Conclusion: Outcomes of patients with aplastic anaemia are improving and patients have a 70% chance of getting cured with a HLA identical sibling donor transplant. The use of PBSC as graft source is not associated with inferior outcomes.
denotes an abstract that is clinically relevant.
denotes that this is a recommended PHD Trainee Session.
denotes that this is a ticketed session.