CONTEXT: aplastic anemia is a bone marrow failure disorder that results from immune-mediated destruction of stem cells. The first line treatment for patients younger than 40 years is MSD transplant if a MSD is available. The goal of transplant is to restore hematopoiesis without GVHD. Graft failure and GVHD are the major causes of transplant failure in this population.
OBJECTIVES: to calculate the frequency of graft failure after MSD transplant for SAA in a homogenously treated cohort of patients (MSD, bone marrow graft, same conditioning), and to study the risk factors that correlate with graft failure.
DESIGN: retrospective study for SAA patients who underwent MSD between January 2003 and January 2017. Logistic regression was used to test the association between graft failure and proposed risk factors. 
PATIENTS: 102 SAA patients underwent MSD transplant at our institution during that period. 95 patients were included after excluding myelodysplasia, congenital BMF, conditioning other than fludarabine and cyclophosphamide and peripheral blood graft. 
INTERVENTIONS: all patients received Flu/Cy conditioning, followed by bone marrow graft, GVHD prophylaxis was standard MTX/CSA
RESULTS: rate of secondary graft failure was 10.5%. TNC < 2× 108 and recipient age >20 were significantly associated with graft failure (p value 0.02, 0.04 respectively). Donor age, CD34, time from diagnosis to transplant and ABO incompatibility did not significantly affect failure rate. 
CONCLUSIONS: graft failure after MSD transplant for SAA at our institution matched published results. Lower TNC and higher recipient-age were significantly associated with graft failure.

04 / Graft failure after matched sibling donor transplant for sever aplastic anemia