Stem Cell Transplantation in Aplastic Anaemia.

The clinical outcome for patients with aplastic anemia (AA) is dependent upon the severity of the pancytopenia and patient age. Allogeneic hematopoietic stem cell transplantation (HSCT) is the best curative treatment for severe and very severe aplastic anemia (SAA) and is the treatment of choice for those less than 50 years of age. The expected five years survivals of patients less than 20 years of age treated with HLA identical sibling HSCT is 88% and between 21-50 years is 72%. However, in patients more than 50 years survival is only 43%.1,2 Therefore HSCT is offered to this group of patients only if immunosuppressive therapy (IST) fails. IST has been effective in the acquired variety of AA with a predicted survival of 67.5% 80% in children1-4 and overall response rates of approximately 60 85% in adults.5 HSCT is particularly desirable in patients with very severe aplastic anemia (VSAA) since these patients have an increased risk of infection and bleeding and are less likely to respond to IST. Human leucocyte antigen (HLA) matched sibling is the donor of choice in patients of SAA being planned for HSCT.