Primary therapy in bone marrow aplasia: Allogeneic transplant of hematopoietic progenitors vs. immunosuppressive therapy

Terapia primaria en aplasia de médula ósea: Trasplante alogénico de progenitores hematopoyéticos vs. terapia inmunosupresora

Background: Bone marrow aplasia (AMO) is a rare disease characterized by a syndrome of medullary failure with peripheral cytopenias and hypo or acellular bone marrow, in the absence of blasts and myelodysplasia. Allogeneic transplantation of hematopoietic progenitors (TAPH) and immunosuppressive therapy (IT) are accepted treatments for patients with this disease. Objective: to determine the overall one-year survival of patients with AMO according to the treatment received. Design: case series study. Place: hematology service of the Hospital de San José and bone marrow transplant unit of the Marly Clinic. Patients: 36 with AMO. Intervention: allogeneic transplantation of hematopoietic progenitors from a related HLA-identical donor or immunosuppressive therapy. Measurement: descriptive analysis was carried out through frequency tables. The probabilities of survival were estimated using the Kaplan-Meier method. Results: the one-year overall survival of the TAPH group was 64% and the TI group 57%. Regarding the prognostic factors, it was found that neutrophil counts> 500 and platelets> 10,000 at the time of diagnosis were associated with greater survival in the first year in the two treatment groups. In addition, a lower transfusional support of both PQ and red blood cells from the diagnosis to the time of treatment has a strong relationship with survival at one year. Conclusion: in patients with AMO, TAPH and TI have very similar survival rates at one year. Abbreviations: AMO, bone marrow aplasia; PQ, platelets; TAPH, allogeneic transplant of hematopoietic progenitors; TI, immunosuppressive therapy; HLA, major histocompatibility antigen.

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