Outcome of adult severe or very severe XXXX treated with immunosuppressive therapy compared with bone marrow transplantation: multicenter trial.

@entity1 @entity2150 @entity2590 @entity3052 @entity205 @entity7965 @entity2132
To compare survival rates and long-term complications after bone marrow transplantation (BMT) or treatment with immunosuppressive agents (ISA) in the management of adult @entity2150 ( @entity2150 ) and to identify prognostic factors associated with improved survival, we evaluated 229 adult @entity2150 @entity1 treated with ISA from 1990 to 2001 and compared the results with those for 64 BMT recipients. Of 156 @entity1 with severe @entity2150 (SAA) or very severe @entity2150 treated with ISA (antithymocyte globulin [ATG] or ATG plus @entity205 ), 46.8% showed complete or partial response and 7.1% had relapses. After long-term follow-up, 1 case each of @entity3052 , @entity2590 , and @entity7965 developed. The 6-year survival rate was 69%. Response to ISA, disease severity, and low absolute neutrophil count (ANC) (< or = 200/mm3) were associated with poor survival. @entity1 age, sex, initial platelet count, etiology, or treatment regimen did not significantly affect survival. Cox regression analysis showed low ANC to be the only pretreatment variable significantly associated with poor survival (P = .000). Of 64 BMT recipients, 82.8% had sustained engraftment, and 12.5% experienced graft failure. Twenty (31.3%) of the @entity1 developed grade II to IV @entity2132 ( @entity2132 ), and 12 (18.8%) of the @entity1 developed chronic @entity2132 . The 6-year survival rate was 79%. @entity1 age and sex, disease severity, etiology, ANC, initial platelet count, and treatment regimen did not affect survival. Survival of 83 @entity2150 @entity1 , aged 14 to 40 years, treated with ISA was not statistically significant from that of 61 adult @entity2150 @entity1 who underwent BMT (6-year survival rate, 65% and 79%, respectively). However, BMT in adult @entity2150 achieved long-term engraftment and a lower relapse rate than ISA. These results suggest that ISA can achieve a high response rate and long-term survival among @entity1 with adult @entity2150 , regardless of disease severity. Further studies with larger numbers of @entity1 and long-term follow-up are needed.
