Abstract
In patients under 40 years of age with ASAA and an HLA identical sibling there are excellent data to support the continued use of allogeneic stem cell transplantation (SCT) as first line curative therapy. In older patients, those without a HLA identical sibling and those with non severe disease (international aplastic anaemia study group criteria) immunosuppressive therapy is the preferred option. Over the past two decades pilot studies have addressed the problem of transplanting young patients with ASAA who have failed 1ST from well matched unrelated donors. In contrast to most haematological malignancies the results have remained significantly inferior to those of identical sibling SCT. The major problem has been unacceptably high transplant related mortality especially in patients over the age of 20 years. In the past 5 years, preliminary data has been more promising using non-ablative reduced intensity conditioning protocols containing fludarabine and ATG with or without low dose total body irradiation.
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