Figure 13.3 shows the survival of patients who received allogeneic BMT for severe aplastic anaemia. Patients who have successful transplants without chronic GvHD have a good quality of life. Children grow normally and have normal endocrine function. Males and females remain fertile and there seems to be no increased risk of congenital abnormalities or miscarriages compared with the normal population. Fertility returns rapidly after the transplant and patients may become pregnant within
3 months while still on cyclosporin. They should be warned of this possibility, although it should be noted that cyclosporin is not teratogenic. Chronic GvHD is the main problem in long-term follow-up, with about 25% of patients being affected.
There are two main types of graft failure seen in aplastic anaemia transplantation. Primary failure is probably related to the disease in that these patients never show any evidence of engraftment. No neutrophils or reticulocytes are seen in the peripheral blood post graft. These patients have a poor outlook and second transplants are usually unsuccessful. Secondary failure occurs after some evidence of engraftment and is probably a true immunological rejection event, although it should be remembered that reactivation of cytomegalovirus infection will also lead to a fall in blood counts. Autologous recovery may still take place, providing that the patient is kept fully supported. Second transplants from the same or another sibling donor have a success rate of about 25%.
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