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Knochenmarktransplantation bei aplastischer Anämie

Bone marrow transplantation for aplastic anaemia

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Summary

From March 1975 until May 1980 twelve patients with severe aplastic anemia were grafted with bone marrow from HLA-identical siblings by the Munich Cooperative Group for Bone Marrow Transplantation. Six patients are alive between 10 months and more than 5 years after grafting with normal blood values and marrow. One patient is treated as an out patient for chronic localized graft-versus-host disease (GvHD), five patients are well and without treatment. Six patients have died, one patient with a cerebral hemorrhage the day before transplantation, three patients following rejection of grafts 32, 40 and 55 days after grafting, one patient with severe GvHD 85 days after grafting and one patient, probably with interstitial pneumonia, following cerebral hemorrhage. Three of 6 patients who were conditioned with Cyclophosphamide (CY) only died following rejection of the graft. Two adults who were conditioned with CY and “total lymphoid irradiation” and three children, who were given unirradiated leukocyte concentrates from the marrow donor after grafting, did not reject their grafts. The results of the Munich-Cooperative Group for Bone Marrow Transplantation are comparable to those of large, specialized centers for bone marrow transplantation, they indicate possibilities of cure of severe aplastic anemia by marrow grafts from HLA-identical siblings. They confirm that better results are obtained with earlier transplantation in the course of the disease.

Zusammenfassung

Im Rahmen der Arbeitsgemeinschaft Knochenmarktransplantation — München (AG-KMT) wurden vom März 1975 bis Mai 1980 insgesamt 12 Patienten wegen schwerer, aplastischer Anämie mit Knochenmarktransplantation (KMT) behandelt. Sechs Patienten überleben derzeit mit normalem Blutbild und Knochenmark zwischen 10 Monaten und mehr als 5 Jahren nach KMT von HLA-identischen Geschwistern, eine Patientin steht noch in ambulanter Behandlung wegen lokalisierter, chronischer Graft-versus-Host Krankheit (GvHK), fünf Patienten sind klinisch gesund. Sechs Patienten starben, ein Patient starb am Tag vor KMT mit Hirnblutung, drei Patienten 32, 40 und 55 Tage nach KMT an den Folgen der Transplantatabstoßung, einer an schwerer GvHK 85 Tage nach KMT und einer 87 Tage nach KMT vermutlich an interstitieller Pneumonie nach Hirnblutung. Drei von 6 Patienten, die nur mit Cyclophosphamid (CY) vorbehandelt waren, starben infolge Abstoßung des Transplantates. Zwei erwachsene Patienten, die mit CY und „total lymphoid irradiation“ vorbehandelt waren, und drei Kinder, die nach KMT unbestrahlte Leukocytenkonzentrate von Knochenmarkspender erhalten hatten, stießen das Transplantat nicht ab.

Die Ergebnisse der AG-KMT sind vergleichbar denen großer, spezialisierter Zentren für KMT und zeigen die Möglichkeiten einer Heilung schwerer aplastischer Anämien durch KMT von HLA-identischen Geschwistern. Die Erfolge sind besser bei frühzeitiger KMT.

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Authors and Affiliations

  1. für die Arbeitsgemeinschaft Knochenmarktransplantation — München (AG-KMT), Germany

    H. J. Kolb

  2. Kinderabteilung des Städt. Krankenhauses Schwabing und Kinderklinik und Kinderpoliklinik der Technischen Universität München, Germany

    G. F. Wündisch, I. Spitzer, H. Öchsler & L. Stengel-Rutkowski

  3. Kinderpoliklinik der Ludwig-Maximilian-Universität München, Germany

    Ch. Bender-Götze & E. D. Albert

  4. Medizinische Klinik des Klinikums Großhadern der Ludwig-Maximilians-Universität München, Germany

    H. J. Kolb, Hj. Sauer, G. Ledderose, G. Brehm, U. Jehn, R. Eckstein, W. Mempel & W. Wilmanns

  5. Dr. von Hauner'sches Kinderspital — Kinderlinik der Ludwig-Maximilians-Universität München, Germany

    R. J. Haas, M. Helmig, B. Netzel, B. Belohradsky & G. Janka

  6. Abt. Immunologie, Institut für Hämatologie, Gesellschaft für Strahlen- und Umweltforschung, Germany

    H. J. Kolb, Hj. Sauer, G. Ledderose, G. Brehm, U. Jehn, R. Eckstein, W. Mempel, W. Wilmanns, H. Rodt, H. Grosse-Wilde & E. Thiel

  7. Klinik und Poliklinik für Radiologie der Ludwig-Maximilians-Universität München, Germany

    H. v. Lieven, R. Roloff, B. L. Krimmel & E. Bunde

  8. Institut für Immunologie der Universität München, Germany

    R. Wank & D. Schendel

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  1. H. J. Kolb
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  2. G. F. Wündisch
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  3. I. Spitzer
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  4. H. Öchsler
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  5. L. Stengel-Rutkowski
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  6. Ch. Bender-Götze
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  17. B. Netzel
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  19. G. Janka
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Additional information

Tumorzentrum München e.V. an den Medizinischen Fakultäten der Ludwig-Maximilian-Universität und der Technischen Universität München

Unterstützt durch den Sonderforschungsbereich 37 der Ludwig-Maximilian-Universität München (Sprecher: Prof. Dr. Dr. h.c. W. Brendel)

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Kolb, H.J., Wündisch, G.F., Spitzer, I. et al. Knochenmarktransplantation bei aplastischer Anämie. Klin Wochenschr 59, 325–341 (1981). https://doi.org/10.1007/BF01525001

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